Columbus, OH — October 2017
Since its introduction in the 1980s, balloon aortic valvuloplasty (BAV) has become the treatment of choice for congenital aortic stenosis. The last thirty years have seen significant improvements in technologies and procedural techniques, so an understanding of modern BAV practices and outcomes is needed.
A recent study from Brian Boe, MD, an interventional pediatric cardiologist in The Heart Center at Nationwide Children’s Hospital, Aimee Armstrong, MD, director of Nationwide Children’s Cardiac Catheterization and Interventional Therapies and their colleagues addresses this knowledge gap. The results support the notion that BAV is a relatively safe and effective way to treat patients with aortic stenosis.
The authors used data from the IMPACT (Improving Pediatric and Adult Congenital Treatments) Registry, an initiative of the American College of Cardiology. Since 2011, the IMPACT Registry has been collecting multicenter data on patients with congenital heart disease who undergo cardiac catheterizations, including BAV procedures. The researchers identified all BAV procedures performed between January 2011 and March 2015 and divided those patients into critical and noncritical aortic stenosis groups.
Over 1,000 BAV procedures were captured in IMPACT, and 70 percent were successful. The researchers defined success conservatively, as not merely survival but if the procedure resulted in adequate relief of the obstruction (opening of the valve), without causing significant regurgitation (valve leak).
“We found a few factors associated with unsuccessful results in the noncritical aortic stenosis group,” says Dr. Boe. “These include patients with a prior cardiac catheterization, patients with both aortic valve stenosis and aortic regurgitation, aortic valves with a high degree of stenosis, procedures performed at training institutions, or procedures using multiple balloon inflations.”
The study did not identify any factors associated with unsuccessful BAV in critical aortic stenosis patients.
No procedural deaths occurred, but 2.4 percent of patients did not survive to hospital discharge. Mortality was more likely in critical patients. Adverse events occurred in just under 16 percent of all cases and were more frequent in patients undergoing BAV for critical aortic stenosis.
In general, the researchers say the study shows BAV is a safe and effective treatment for congenital aortic stenosis, although patients with critical aortic stenosis are at a higher risk for complications and death.
“Currently, there are recommended guidelines for the interventional cardiologist performing BAV, which can be done safely and successfully in many patients,” says Dr. Boe. “Our study highlights this fact and the factors which put some patients at a higher risk for adverse events.”
Boe, B. A., Zampi, J. D., Kennedy, K. F., Jayaram, N., Porras, D., Foerster, S. R., Armstrong, A. K. Acute success of balloon aortic valvuloplasty in the current era: a national cardiovascular data registry study. JACC: Cardiovascular Interventions 2017 Sep 11; 10 (17): 1717-1726.