Efficacy and safety of a minimalistic balloon aortic valvuloplasty strategy in a centre without heart surgery.

Autor:	Bruno M; Cardiology Department, Ospedale Maggiore, Bologna, Italy and Azienda USL di Bologna, Bologna, Italy., Iannopollo G; Cardiology Department, Ospedale Maggiore, Bologna, Italy and Azienda USL di Bologna, Bologna, Italy., Cardelli LS; Cardiology Department, Ospedale Maggiore, Bologna, Italy and Azienda USL di Bologna, Bologna, Italy., Capecchi A; Cardiology Department, Ospedale Maggiore, Bologna, Italy and Azienda USL di Bologna, Bologna, Italy., Lanzilotti V; Cardiology Department, Ospedale Maggiore, Bologna, Italy and Azienda USL di Bologna, Bologna, Italy., Verardi R; Cardiology Department, Ospedale Maggiore, Bologna, Italy and Azienda USL di Bologna, Bologna, Italy., Pedone C; Cardiology Department, Ospedale Maggiore, Bologna, Italy and Azienda USL di Bologna, Bologna, Italy., Nobile G; Cardiology Department, Ospedale Maggiore, Bologna, Italy and Azienda USL di Bologna, Bologna, Italy., Casella G; Cardiology Department, Ospedale Maggiore, Bologna, Italy and Azienda USL di Bologna, Bologna, Italy.
Jazyk:	angličtina
Zdroj:	AsiaIntervention [AsiaIntervention] 2024 Feb 29; Vol. 10 (1), pp. 40-50. Date of Electronic Publication: 2024 Feb 29 (Print Publication: 2024).
DOI:	10.4244/AIJ-D-23-00041
Abstrakt:	Background: Balloon aortic valvuloplasty (BAV) is a palliative tool for patients with symptomatic severe aortic stenosis (AS) at prohibitive risk for surgery or as a bridge to surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). BAV is traditionally performed in hospitals with onsite cardiac surgery due to its potential complications. Aims: The aim of this study was to evaluate the safety of BAV procedures performed by trained high-volume operators in a centre without onsite surgery and to assess the effect of a minimalistic approach to reduce periprocedural complications. Methods: From 2016 to 2021, 187 BAV procedures were performed in 174 patients. Patients were elderly (mean age: 85.0±5.4 years) and had high-risk (mean European System for Cardiac Operative Risk Evaluation score [EuroSCORE] II: 10.1±9.9) features. According to the indications, 4 cohorts were identified: 1) bridge to TAVR (n=98; 56%); 2) bridge to SAVR (n=8; 5%); 3) cardiogenic shock (n=11; 6%); and 4) palliation (n=57; 33%). BAV procedures were performed using the standard retrograde technique via femoral access in 165 patients (95%), although radial access was used in 9 patients (5%). Ultrasound-guided vascular puncture was performed in 118 patients (72%) and left ventricular pacing was administered through a stiff guidewire in 105 cases (60%). Results: BAV safety was confirmed by 1 periprocedural death (0.6%), 1 intraprocedural stroke (0.6%), 2 major vascular complications (1%) and 9 minor vascular complications (5%). Nine cases of in-hospital mortality occurred (5%), predominantly in patients with cardiogenic shock. Conclusions: BAV is a safe procedure that can be performed in centres without onsite cardiac surgery using a minimalistic approach that can reduce periprocedural complications. Competing Interests: The authors have no conflicts of interest to declare.
Databáze:	MEDLINE
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