SEVERE MITRAL REGURGITATION AFTER PMBV? COMPARISON BETWEEN INOUE AND MULTI-TRACK TECHNIQUES

Objectives: To compare the frequency of severe mitral regurgitation after percutaneous mitral balloon valvuloplasty (PMBV) via Inoue balloon and multi-track balloon technique in our population. Methodology: In this retrospective observational study which was conducted at a tertiary care cardiac center of Karachi, Pakistan between 2015 and 2020 on Hospital registry of PMBV patients. Data were categorized in to two groups, Inoue balloon or multi-track balloon technique. Post procedure echocardiographic and catheterization parameters and in-hospital outcomes and complications, including severe MR, were compared between two groups. Results: Out of 470 PMBV procedures, 286 (60.9%) were performed with multi-track and 184 (39.1%) with Inoue balloon. Improvement in mitral value area was significantly higher with multi-track as compared to Inoue balloon (0.66±0.31 cm2 vs. 0.56±0.29 cm2; p<0.001). Severe MR was not significant, 3.5% (10/286) vs. 4.3% (8/184); p=0.639 for multi-track and Inoue balloon. One patient in Inoue balloon group and two patients in multi-track group required emergency valve surgery. Stroke was observed in two patients of multi-track group and two patients from the same group developed tamponade. No in-hospital mortality was observed. Conclusion: Post-procedure severe MR is a significant and frequent complication. Rate of post procedure severe MR are similar for PMBV via Inoue balloon and multi-track balloon. Both methods are equally effective with equal success rate.

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

Rapid 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.

Transcatheter Closure of Atrial Septal Defect and Balloon Pulmonary Valvuloplasty with Inoue Balloon in Adult Patients.

Secundum type atrial septal defect combined with pulmonic stenosis is a relatively uncommon condition in adult patients. When occurred separately they can be treated with transcatheter intervention. When they occur together ideal treatment option is not clear. We report a case of combined percutaneous pulmonary valvuloplasty done with the Inoue balloon and transcatheter atrial septal defect closure in an adult patient.

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

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.

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

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

Percutaneous mitral balloon valvuloplasty. Single versus Inoue balloon. long term follow-up

Introduction The single balloon (SB) is the less expensive technique to perform mitral balloon valvuloplasty (MBV). Objectives: This study aimed to demonstrate that MBV with the Balt single (BSB) and Inoue ballon, the wordwire accepted technique, had similar outcome and long-term follow-up (FU). Methods From 1987 to 2013, 526 procedures were performed, being 312 with a FU, 56 (17,9%) with Inoue balloon (IB) and 256 (82,1%) with BSB. The mean FU 156±144 months, p&lt;0.0001. Univariate analysis (UA) and multivariate Cox analysis (MCA) to determine independent predict variables of survival and event free survival (EFS) of death, cardiac surgery and new MBV, in both techniques groups. Results In IB and BSB groups there were, respectively: female 42 (75.0%) and 222 (86.7%); mean age 37.3±10.0 (19 to 63) and 38.0±12.6 (13 to 83) years, p=0.7138; sinus rhythm 51 (91.1%) and 215 (84.0%), p=0.1754; echo score (ES) 7.6±1.3 (5 to 10) and 7.2±1.5 (4 to 14) points, p=0.0528; echo mitral valve area (MVA) pre-MBV 0.96±0.18 and 0.93±0.21 cm2, p=0.2265; post-MBV mean MVA (Gorlin) were 2.00±0.52 and 2.02±0.37 cm2, p=0.9554; MBV dilatation área 6,09±0,27 and 7,02±0,30, p&lt;0,0001. At the end of the FU, there were in IB and BSB groups, respectively: echo MVA 1.71±0.41 and 1.54±0.51 cm2, p=0.0552; new severe mitral regurgitation in 5 (8.9%) and 17 (6.6%) patients, p=0.5633; new MBV in 1 (1.8%) and 13 (5.1%), p=0.4779; mitral valve surgery in 3 (5.4%) and 27 (10.4%), p=0.3456; deaths 2 (3.6%) and 11 (4.3%), p=1.000; cardiac deaths 1 (1.8%) and 9 (3.5%), p=1.000; ME 5 (8.9%) and 46 (18.0%), p=0.1449. In UA and MCA the BSB or IB technique do not predict survival or EFS. The independent risk factors to survival were: age &lt;50 years (p=0.016, HR=0.233, 95% IC 0.071- 0.764), ES ≤8 (p&lt;0.001, HR=0.105, 95% IC 0.34–0.327), MBV dilatation area (p&lt;0.001, HR 16.838, 95% IC 3.353–84.580) and no mitral valve surgery in the FU (p=0.001, HR0.152, 95% IC 0.050–0.459). Independent risk factors to EFS: no prior commissurotomy (p=0.012, HR=0.390, 95% IC 0.187–0.813) and post-MBV MVA ≥1.50 cm2 (p=0.001, HR=7.969, 95% IC 3.413–18.608). Conclusion In 25 years, survival and EFS were similar in BSB and IB technique. Independent predictors of surviva: age &lt;50 years, ES≤8 points, MBV dilatation area &gt;7 mm2 and no mitral valve surgery in the FU. Independent predictors of EFS: no prior commissurotomy and post-MBV MVA≥1.50 cm2 Funding Acknowledgement Type of funding source: None

The balloon impasse sign in percutaneous transvenous mitral valvuloplasty

ABSTRACT Percutaneous transvenous mitral valvuloplasty (PTMV) is an established therapy for rheumatic mitral stenosis (MS). While the Wilkins score standardizes the description of valve anatomy and predicts successful PTMV, echocardiographic assessment has some limitations. The ‘balloon impasse’ sign is the inability to cross a stenotic valve with a deflated Inoue balloon. This sign was described in the 1990s as an indicator of severe subvalvular thickening (regardless of the echocardiographic findings), portending an increased risk of severe mitral regurgitation (MR) post-PTMV. Despite its implications for management, it has been seldom reported. A 57-year-old woman with symptomatic, severe MS and a Wilkins score of 7 underwent PTMV. The ‘balloon impasse’ sign was observed when attempting to cross the stenotic valve. When the balloon was fully inflated, severe MR was noted, and the patient required mitral valve replacement. This case demonstrates the continued importance of the ‘balloon impasse’ sign and its implications for the therapeutic efficacy of PTMV.