Efficacy and safety of percutaneous transcatheter aortic valvuloplasty prior to non-cardiac surgery in Japanese patients with severe aortic stenosis

Abstract Background. Balloon aortic valvuloplasty (BAV) is a percutaneous treatment option for severe, symptomatic aortic stenosis. Due to early restenosis and failure to improve long term survival, BAV is considered a palliative measure in patients who are not suitable for open heart surgery due to increased perioperative risk. BAV can be used also as a bridge to surgical or transcatheter aortic valve implantation (TAVI) in haemodinamically unstable patients or in patients who require urgent major non-cardiac surgery. Patients and methods. We reported on 6 oncologic patients with severe aortic stenosis that required a major abdominal and gynaecological surgery. In 5 cases we performed BAV procedure alone; in one patient with concomitant coronary artery disease we combined BAV and percutaneous coronary intervention (PCI). Results. With angioplasty and BAV we achieved a good coronary artery flow and an increase in aortic valve area without any periprocedural complications. After the successful procedure, we observed a hemodynamic and symptomatic improvement. As a consequence the operative risk for non-cardiac surgery decreased and the surgical treatment of cancer was done without complications in all the 6 cases. Conclusions. BAV can be utilized as a part of a complex therapy in severe aortic stenosis aimed to improve the quality of life, decrease the surgical risk for major non-cardiac surgery or as a bridge to surgical or transcatheter aortic valve implantation.

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Balloon aortic valvuloplasty for severe aortic stenosis before urgent non-cardiac surgery

EuroIntervention ◽

10.4244/eij-d-20-01423 ◽

2021 ◽

Vol 17 (8) ◽

pp. e680-e687 ◽

Cited By ~ 1

Author(s):

Nicolas Debry ◽

Alexandre Altes ◽

Flavien Vincent ◽

Cédric Delhaye ◽

Guillaume Schurtz ◽

...

Keyword(s):

Cardiac Surgery ◽

Aortic Stenosis ◽

Severe Aortic Stenosis ◽

Balloon Aortic Valvuloplasty ◽

Aortic Valvuloplasty

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3538 Predictors of mortality in patients with severe aortic stenosis while waiting for cardiac surgery

European Heart Journal ◽

10.1016/s0195-668x(03)96144-6 ◽

2003 ◽

Vol 24 (5) ◽

pp. 688

Author(s):

J ALONSO

Keyword(s):

Cardiac Surgery ◽

Aortic Stenosis ◽

Severe Aortic Stenosis ◽

Predictors Of Mortality

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A Novel Approach: Trans-ascending Aorta Balloon Aortic Valvuloplasty via Sternotomy for Treating Severe Valvular Aortic Stenosis in a Low-Weight Infant

The Heart Surgery Forum ◽

10.1532/hsf98.2013277 ◽

2014 ◽

Vol 17 (1) ◽

pp. 25 ◽

Cited By ~ 1

Author(s):

Lei Gao ◽

Qin Wu ◽

Xinhua Xu ◽

Tianli Zhao ◽

Wancun Jin ◽

...

Keyword(s):

Aortic Stenosis ◽

Transesophageal Echocardiography ◽

Severe Aortic Stenosis ◽

Ascending Aorta ◽

Balloon Aortic Valvuloplasty ◽

Congenital Aortic Stenosis ◽

Novel Approach ◽

Low Weight ◽

Aortic Valvuloplasty ◽

Peak Gradient

Background: Severe congenital aortic stenosis in infants is a life-threatening congenital heart anomaly that is typically treated using percutaneous balloon aortic valvuloplasty.Methods: The usual route is the femoral artery under radiographic guidance. However, this procedure may be limited by the small size of the femoral artery in low-weight infants. An infant weighing only 7 kg with severe aortic stenosis (peak gradient was 103 mmHg) was successfully treated with a novel approach, that is trans-ascending aorta balloon aortic valvuloplasty guided by transesophageal echocardiography.Results: The patient tolerated the procedure well, and no major complications developed. After the intervention, transesophageal echocardiography indicated a significant reduction of the aortic valvular peak gradient from 103 mmHg to 22 mmHg, no aortic regurgitation was found. Eighteen months after the intervention, echocardiography revealed that the aortic valvular peak gradient had increased to 38 mmHg and that still no aortic regurgitation had occurred.Conclusions: In our limited experience, trans-ascending aorta balloon aortic valvuloplasty for severe aortic stenosis under transesophageal echocardiography guidance effectively reduces the aortic peak gradient. As this is a new procedure, long-term follow up and management will need to be established. It may be an alternative technique to treat congenital aortic stenosis in low-weight patients.

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Balloon aortic valvuloplasty of severe aortic stenosis in the era of TAVR

Srce i krvni sudovi ◽

10.5937/siks1401021k ◽

2014 ◽

Vol 33 (4) ◽

pp. 21-26

Author(s):

P. Kogoj ◽

T. Furlan ◽

M. Bunc

Keyword(s):

Aortic Stenosis ◽

Severe Aortic Stenosis ◽

Balloon Aortic Valvuloplasty ◽

Aortic Valvuloplasty

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Antegrade Balloon Aortic Valvuloplasty for the Highly Frail Patient of Severe Aortic Stenosis Complicated with Transthyretin-type Cardiac Amyloidosis

Internal Medicine ◽

10.2169/internalmedicine.3870-19 ◽

2020 ◽

Vol 59 (8) ◽

pp. 1053-1057

Author(s):

Shohei Yoshida ◽

Hayato Tada ◽

Tetsuo Nishikawa ◽

Tamami Nakagawa-Kamiya ◽

Takuya Nakahashi ◽

...

Keyword(s):

Aortic Stenosis ◽

Cardiac Amyloidosis ◽

Severe Aortic Stenosis ◽

Balloon Aortic Valvuloplasty ◽

Frail Patient ◽

Aortic Valvuloplasty

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Effect of Balloon Aortic Valvuloplasty on Mortality in Patients With Severe Aortic Stenosis Prior to Conservative Treatment and Surgical or Transcatheter Aortic Valve Replacement

Heart Lung and Circulation ◽

10.1016/j.hlc.2019.06.717 ◽

2020 ◽

Vol 29 (5) ◽

pp. 719-728 ◽

Cited By ~ 1

Author(s):

Dylan R. Jones ◽

Derek P. Chew ◽

Matthew J. Horsfall ◽

Anthony M. Chuang ◽

Ajay R. Sinhal ◽

...

Keyword(s):

Aortic Valve ◽

Conservative Treatment ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Severe Aortic Stenosis ◽

Balloon Aortic Valvuloplasty ◽

Transcatheter Aortic Valve ◽

Aortic Valvuloplasty

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Aortic Balloon Valvuloplasty Prior to Orthotopic Liver Transplantation: A Novel Approach to Aortic Stenosis and End-Stage Liver Disease

Case Reports in Cardiology ◽

10.1155/2014/325136 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Edward Coverstone ◽

Kevin Korenblat ◽

Jeffrey S. Crippin ◽

William C. Chapman ◽

Andrew M. Kates ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Aortic Valve ◽

Aortic Stenosis ◽

Orthotopic Liver Transplantation ◽

Severe Aortic Stenosis ◽

Balloon Aortic Valvuloplasty ◽

End Stage Liver Disease ◽

Aortic Valvuloplasty ◽

End Stage

The combination of severe aortic stenosis and end-stage liver disease increases the morbidity and mortality of surgical aortic valve replacement or orthotopic liver transplantation resulting in a prohibitive operative risk. We propose a staged approach of balloon aortic valvuloplasty prior to orthotopic liver transplantation as a bridge to definitive aortic valve replacement. Between 2010 and 2012, four patients with severe aortic stenosis and end-stage liver disease underwent staged balloon aortic valvuloplasty followed by orthotopic liver transplantation. All patients had been deemed to be inappropriate candidates for liver transplantation or aortic valve surgery due to their comorbidity. One patient died of complications from a perivalvular abscess. Three patients went on to successful graft implantation and function and surgical recovery. Two of the three patients proceeded to definitive surgical aortic valve replacement with the remainder currently undergoing evaluation. In this case series, we present a novel approach of balloon aortic valvuloplasty prior to liver transplantation as a potential bridge to definitive treatment of severe aortic stenosis in the end-stage liver patient.

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