Tiziana Attisano1, Angelo Silverio1, Eugenio Stabile2, Carlo Briguori3, Bernardino Tuccillo4, Fortunato Scotto Di Uccio4, Emilio Di Lorenzo5, Tullio Tesorio6, Arturo Giordano7, Paolo Calabrò8, Maurizio Cappelli Bigazzi9, Paolo Golino9, Marino Scherillo10, Francesco Vigorito1, Gaetano Quaranta11, Giovanni Esposito2, Ciro Mauro12, Giuseppe Musumeci13, Giuseppe Tarantini14, Gennaro Galasso1. 1. Interventional Cardiology Unit, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy. 2. Division of Cardiology, Department of Advanced Biomedical Sciences, Università Federico II, Naples, Italy. 3. Interventional Cardiology Unit, Clinica Mediterranea, Naples, Italy. 4. Cardiology Unit, Santa Maria di Loreto Mare Hospital, Naples, Italy. 5. Cardiology Department, G. Moscati Hospital, Avellino, Italy. 6. Interventional Cardiology Service, Casa di Cura Montevergine, Mercogliano, Avellino, Italy. 7. Interventional Cardiology Unit, Clinica Pineta Grande, Castelvolturno, Caserta, Italy. 8. Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy. 9. Cardiology-CCU Unit, A.O.R.N. dei Colli, Naples, Italy. 10. Cardiology Unit, G. Rummo Hospital, Benevento, Italy. 11. Cardiology Unit, Umberto I Hospital, Nocera Inferiore, Italy. 12. Cardiovascular Department, Antonio Cardarelli Hospital, Naples, Italy. 13. Cardiology Unit, Santa Croce e Carle Hospital, Cuneo, Italy. 14. Department of Cardiac, Thoracic and Vascular sciences, University of Padua, Padua, Italy.
Abstract
OBJECTIVES: To evaluate the safety and the feasibility of balloon aortic valvuloplasty (BAV) procedure made by trained operators in centers not performing transcatheter aortic valve implantation (TAVI). BACKGROUND: BAV is a valuable therapeutic tool for patients with symptomatic severe aortic valve stenosis (AS) at prohibitive risk for TAVI or surgery. METHODS: Consecutive high-risk AS patients underwent BAV in five non-TAVI centers, where BAV operators had completed a 6-month training period in high-volume TAVI centers (Group A). All clinical, echocardiographic, and procedural data were prospectively collected and compared with data of patients treated in TAVI center (Group B). RESULTS: Between June 2016 and June 2017, 55 patients (83.9 ± 7.0 years) were enrolled: 25 in Group A and 30 in Group B. After BAV, a substantial reduction of the peak-to-peak aortic valve gradient was obtained in both groups (-35.3 ± 15.2 vs -28.8 ± 13.9 mmHg, P =0.25). No major bleeding or vascular complications occurred. In-hospital death was observed in three patients of Group A and two patients of Group B (P =0.493). The mean follow-up time was 303 ± 188 days; no patients were lost. The 1-year survival free from overall death (Group A 75.8% vs Group B 68.8%; P =0.682) and heart failure rehospitalization (Group A 73.0% vs Group B 66.8%; P =0.687) was similar in the two groups. At multivariable analysis, low left ventricular (LV) ejection fraction (HR: 0.943; P = 0.011) and cardiogenic shock (HR: 5.128; P = 0.002) at admission were independent predictors of mortality. CONCLUSIONS: BAV is a safe and effective procedure that can be performed by trained operators in centers not performing TAVI.
OBJECTIVES: To evaluate the safety and the feasibility of balloon aortic valvuloplasty (BAV) procedure made by trained operators in centers not performing transcatheter aortic valve implantation (TAVI). BACKGROUND:BAV is a valuable therapeutic tool for patients with symptomatic severe aortic valve stenosis (AS) at prohibitive risk for TAVI or surgery. METHODS: Consecutive high-risk AS patients underwent BAV in five non-TAVI centers, where BAV operators had completed a 6-month training period in high-volume TAVI centers (Group A). All clinical, echocardiographic, and procedural data were prospectively collected and compared with data of patients treated in TAVI center (Group B). RESULTS: Between June 2016 and June 2017, 55 patients (83.9 ± 7.0 years) were enrolled: 25 in Group A and 30 in Group B. After BAV, a substantial reduction of the peak-to-peak aortic valve gradient was obtained in both groups (-35.3 ± 15.2 vs -28.8 ± 13.9 mmHg, P =0.25). No major bleeding or vascular complications occurred. In-hospital death was observed in three patients of Group A and two patients of Group B (P =0.493). The mean follow-up time was 303 ± 188 days; no patients were lost. The 1-year survival free from overall death (Group A 75.8% vs Group B 68.8%; P =0.682) and heart failure rehospitalization (Group A 73.0% vs Group B 66.8%; P =0.687) was similar in the two groups. At multivariable analysis, low left ventricular (LV) ejection fraction (HR: 0.943; P = 0.011) and cardiogenic shock (HR: 5.128; P = 0.002) at admission were independent predictors of mortality. CONCLUSIONS:BAV is a safe and effective procedure that can be performed by trained operators in centers not performing TAVI.
Authors: Łukasz Kuźma; Jolanta Małyszko; Hanna Bachórzewska-Gajewska; Marta Maria Niwińska; Anna Kurasz; Małgorzata Zalewska-Adamiec; Marcin Kożuch; Sławomir Dobrzycki Journal: Int Urol Nephrol Date: 2020-07-14 Impact factor: 2.370