scholarly journals Safety and feasibility of retrograde inoue balloon for balloon aortic valvuloplasty without rapid ventricular pacing during transcatheter aortic valve implantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Ninomiya ◽  
M Ishida ◽  
K Tosaka ◽  
N Kanehama ◽  
Y Ishikawa ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Cardiopulmonary Arrest ◽  
Ventricular Pacing ◽  
Balloon Aortic Valvuloplasty ◽  
Transcatheter Aortic Valve ◽  
Aortic Valvuloplasty ◽  
Prolonged Hypotension ◽  
Rapid Ventricular Pacing ◽  
Inoue Balloon ◽  
Valve Implantation

Abstract Background Although rapid ventricular pacing (RVP) is commonly performed for preparation of transcatheter aortic valve implantation (TAVI). It has been reported that multiple and / or prolonged RVP is associated with adverse clinical outcomes of TAVI. Retrograde Inoue-Balloon was designed for balloon aortic valvuloplasty (BAV) without RVP to prevent slip of balloon by way of central waist during biphasic inflation. Purpose The purpose of this study was to evaluate safety and feasibility of Retrograde Inoue-Balloon for TAVI preparation. Methods From December 2013 to December 2019, 427 consecutive patients who performed TAVI for severe aortic valve stenosis, were retrospectively enrolled in Iwate Medical University. Of them, 227 (53%) patients (mean age 83±5 years, male 41%), underwent retrograde BAV before prosthetic valve implantation, comprised this study population. Retrograde BAV procedures were divided into two groups; patients used Inoue-Balloon without RVP and those did conventional balloon with RVP. The primary endpoint was defined as combined adverse events of 30-day mortality, cerebral infarction, and critical complications after BAV (aortic dissection, aortic rupture and cardiopulmonary arrest). The secondary endpoint was set as prolonged hypotension after BAV. Result Inoue-Balloon (IB) and conventional balloon (CB) were used for 73 patients (32%) and 154 (68%) patients, respectively. Both balloons were succeeded to through and expand of aortic valve in all cases. In the CB group, cardiopulmonary arrest occurred in 2.0% after BAV, cerebral infarction was observed in 3.9%, and 30-day death in 3.3%. On the other hand, no major complications were observed except one aortic dissection in the IB group. In logistic regression analysis adjusted by sex and age, the incidence of combined adverse events was significantly lower in the IB group (OR 0.17, 95% CI 0.009–0.917, P=0.037). Furthermore, the IB group had significantly a lower incidence of prolonged hypotension following BAV compared with CB group (4.1% vs 19.5%, p=0.002). Conclusion Balloon aortic valvuloplasty using retrograde Inoue-balloon without rapid ventricular pacing is safe and feasible, and may improve clinical outcomes of TAVI. Funding Acknowledgement Type of funding source: None

scholarly journals Safety and feasibility of retrograde INOUE-BALLOON for balloon aortic valvuloplasty without rapid ventricular pacing during transcatheter aortic valve replacement

2021 ◽  
Author(s):  
Ryo Ninomiya ◽  
Michiko Yoshizawa ◽  
Yorihiko Koeda ◽  
Yu Ishikawa ◽  
Akiko Kumagai ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Ventricular Pacing ◽  
Balloon Aortic Valvuloplasty ◽  
Transcatheter Aortic Valve ◽  
Aortic Valvuloplasty ◽  
Prolonged Hypotension ◽  
Rapid Ventricular Pacing ◽  
Inoue Balloon

AbstractRapid ventricular pacing (RVP) is commonly employed during transcatheter aortic valve replacement (TAVR); however, frequent TAVR is associated with worse prognoses. The retrograde INOUE-BALLOON® (IB) allows balloon aortic valvuloplasty (BAV) without RVP. The aim of this study was to evaluate the feasibility of retrograde IB for TAVR preparation. The study population included 178 consecutive patients (mean age, 84 ± 5 years; male, 47%) who underwent retrograde BAV before prosthetic valve replacement via the transfemoral approach. Patients were divided into a retrograde IB group without RVP (n = 74) and a conventional balloon (CB) group with RVP (n = 104). The primary endpoint was prolonged hypotension after BAV (reduced systolic pressure < 80 mmHg for over 1 min or vasopressor drug requirement). The incidence of prolonged hypotension after BAV was significantly lower in the IB group compared with the CB group (4% vs. 16%, p = 0.011). Balloons were able to penetrate and expand the aortic valve in both groups. RVP was used less for total TAVR in the IB group compared with the CB group. The aortic valve area-index after BAV was not significantly different between the two groups (0.72 ± 0.14 cm2/m2 vs. 0.71 ± 0.12 cm2/m2; p = 0.856). Multivariate analysis demonstrated that IB use was associated with avoidance of prolonged hypotension (OR, 0.27 [0.059–0.952]; p = 0.041). In conclusion, BAV using retrograde IB without RVP is both safe and feasible. More stable hemodynamics were achieved using retrograde IB by avoiding RVP during TAVR.

scholarly journals Retrograde balloon aortic valvuloplasty with the newly invented Inoue balloon for aortic stenosis accompanied by severe heart failure: a case report

2021 ◽  
Author(s):  
Keinchi Ishizu ◽  
Tomohiro Kawaguchi ◽  
Shinichi Shirai ◽  
Kenji Ando
Keyword(s):  
High Risk ◽  
Severe Heart Failure ◽  
Ventricular Pacing ◽  
Stable Fixation ◽  
Balloon Aortic Valvuloplasty ◽  
Transcatheter Aortic Valve ◽  
Aortic Valvuloplasty ◽  
Risk Patients ◽  
Rapid Ventricular Pacing ◽  
Inoue Balloon

Balloon aortic valvuloplasty (BAV) is frequently utilized for selected high-risk patients who cannot be immediate candidates for transcatheter aortic valve replacement. We describe a case of high-risk retrograde BAV performed safely with a newly invented Inoue balloon with stable fixation and multistage inflation characteristics, without any rapid ventricular pacing requirements.

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