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Usefulness of balloom aortic valvuloplasty in the management of patients with aortic stenosis

Session Poster Session 4

Speaker Manuel Munoz-Garcia

Congress : Heart Failure 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Valvular Heart Disease - Treatment
  • Session type : Poster Session
  • FP Number : P2137

Authors : E Munoz-Garcia (Malaga,ES), M Munoz-Garcia (Malaga,ES), A J Munoz Garcia (Malaga,ES), JH Alonso-Briales (Malaga,ES), C Alonso-Laza (Malaga,ES), AJ Dominguez-Franco (Malaga,ES), JM Garcia-Pinilla (Malaga,ES), JJ Gomez-Doblas (Malaga,ES), JM Hernandez-Garcia (Malaga,ES), MF Jimenez-Navarro (Malaga,ES)

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Authors:
E Munoz-Garcia1 , M Munoz-Garcia1 , A J Munoz Garcia1 , JH Alonso-Briales1 , C Alonso-Laza1 , AJ Dominguez-Franco1 , JM Garcia-Pinilla1 , JJ Gomez-Doblas1 , JM Hernandez-Garcia1 , MF Jimenez-Navarro1 , 1University Hospital Virgen de la Victoria, Department of Cardiology - Malaga - Spain ,

Citation:

The introduction of Transcatheter Aortic Valve Implantation (TAVI) has generated a renewed interest in the treatment of patients with severe aortic stenosis. The aim of our study was to analyze the indications and survival of patients with severe aortic stenosis treated with balloon aortic valvuloplasty (BAV).

Methods:  Between 2005 and 2017, 159 consecutive patients with severe aortic stenosis were treated with BAV at our center. Three cohorts of patients were identified according to the definitive treatment performed: A) bridge to TAVI n = 67 B) bridge to surgical aortic valve replacement (AVR) n = 70 and C) medical-palliative treatment n = 22.

Results:  The mean age of patients was 76.8±8 years, and had a high surgical risk, (mean logistic EuroSCORE 24.17±14%, and EuroSCORE II 9.01±6. There were differences in the gender, according to definitive planned therapy, being the most prevalent female sex for TAVI compared with AVR and palliative therapy (53.9% vs. 31.3% vs. 40%,  p = 0.012).  Highlight that 33 patients (20.8%) were in cardiogenic shock. The success of the procedure was 96.9%. Two patients died during the procedure. In-hospital mortality was 17.6% and occurred mainly in patients with cardiogenic shock [OR = 9.84 (95% CI 3.91-24.7) p <0.001]. The rate of major events was 14.6%. The mean survival in patients to bridge TAVI was 51 months (95% CI 42-60.2), to AVR was 83 months (95% CI 58.9-107.6) and medical-palliative treatment was 6.2 months (95% CI 3.208- 9.26), log Rank 102, p <0.001. Frailty was an independent predictor of late mortality [HR=4.310 (95% CI 1.98-9.38), p< 0.001).

Conclusion:  In our series, the number of BAV has increased due to the introduction TAVI. The procedure is safe and the mean survival was acceptable for the population of patients receiving subsequent definitive treatment. Cardiogenic shock conditions in-hospital mortality, and the frailty of patients (based on the Fried scale) is a predictor of late mortality that should be considered in the clinical evaluation

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