Mortality after radial-only balloon aortic valvuloplasty: a long-term follow-up and a bridge-to-TAVI analysis
, , , , , , , and | Aug 01, 2023
About this article
Article Category: Original Article
Published Online: Aug 01, 2023
Page range: 93 - 98
DOI: https://doi.org/10.2478/rjc-2023-0014
Keywords
© 2023 Alexandru Achim et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Figure 1
Figure 2
Effect of BAV. CCS, Canadian Cardiovascular Society; NYHA, New York Heart Association; LVEF, left ventricular ejection fraction; LV, left ventricle; EDD, end diastolic diameter; ESD, end systolic diameter; AI, aortic insufficiency
| Before BAV | After BAV | P-value | |
|---|---|---|---|
| Angina class (CCS) | 0.025 | ||
| 0 | 16 (53.3%) | 23 (76.7%) | |
| 1 | 2 (6.67%) | 5 (16.7%) | |
| 2 | 5 (16.7%) | 2 (6.67%) | |
| 3 | 3 (10.0%) | 0 (0.0%) | |
| 4 | 4 (13.3%) | 0 (0.0%) | |
| NYHA class | <0.001 | ||
| 1 | 0 (0.0%) | 8 (26.7%) | |
| 2 | 0 (0.0%) | 18 (60.0%) | |
| 3 | 15 (50.0%) | 2 (6.67%) | |
| 4 | 15 (50.0%) | 2 (6.67%) | |
| Peak-to-peak gradient across aortic valve, mmHg | 94.6±31.9 | 40.0±15.6 | <0.001 |
| LVEF, % | 47.9±17.6 | 50.2±13.8 | 0.593 |
| LV EDD, mm | 52.0 (45.2-59.0) | 48.0 (44.5-58.0) | 0.585 |
| LV ESD, mm | 36.7±9.60 | 37.2±8.21 | 0.773 |
| Aortic valve peak gradient, mmHg | 87.1±8.8 | 63.3±29.3 | 0.004 |
| Aortic valve mean gradient, mmHg | 56.0±20.2 | 36.7±14.0 | 0.092 |
| AI grade | 0.515 | ||
| 0 | 14 (46.6%) | 3 (10%) | |
| 1 | 10 (33.3%) | 14 (46.6%) | |
| 2 | 5 (16.6%) | 12 (40%) | |
| 3 | 1 (3.33%) | 1 (3.33%) | |
Procedural characteristics
| Variable | Value |
|---|---|
| Sheath #1 size (French) | |
| 5, n (%) | 1 (3.33%) |
| 6, n (%) | 1 (3.33%) |
| 7, n (%) | 13 (43.3%) |
| 8, n (%) | 12 (40.0%) |
| 9, n (%) | 1 (3.33%) |
| 10, n (%) | 2 (6.67%) |
| Sheath #2 size (French) | |
| 5, n (%) | 3 (10.0%) |
| 6, n (%) | 24 (80.0%) |
| 7, n (%) | 2 (6.67%) |
| 8, n (%) | 1 (3.33%) |
| Balloon size | |
| 14x20, n (%) | 1 (3.33%) |
| 14x40, n (%) | 2 (6.67%) |
| 16x20, n (%) | 1 (3.33%) |
| 16x40, n (%) | 12 (40.0%) |
| 18x40, n (%) | 13 (43.3%) |
| 2x12x40, n (%) | 1 (3.33%) |
| Contrast volume, mL | 82.7 (39.8) |
| Procedure time, min | 48.2 (12.5) |
Patient characteristics. TAVI, transcatheter aortic valve implantation; BMI, body mass index; CKD, chronic kidney disease; DM, diabetes mellitus; AHT, arterial hypertension; MI, myocardial infarction; CABG, coronary artery bypass grafting; COPD, chronic obstructive pulmonary disease; CVA, cerebrovascular accident; balloon aortic valvuloplasty, BAV.
| All patients (N=30) | BAV only (N=14) | BAV + TAVI (N=16) | P-value | |
|---|---|---|---|---|
| Length of follow-up, months | 22.8 (21.3-24.3) | 21.9 (10.4-24.2) | 23.0 (22.1-24.3) | 0.253 |
| Time to TAVI, months | 3.33 (2.49-4.38) | NA | ||
| Age, years | 78.3±7.14 | 79.4±5.62 | 77.4±8.31 | 0.443 |
| Male, n (%) | 12 (40.0%) | 5 (35.7%) | 7 (43.8%) | 0.940 |
| BMI, kg/m2 | 26.7 (23.2-29.4) | 26.6 (24.0-29.3) | 26.7 (22.8-29.3) | 0.835 |
| CKD, n (%) | 15 (50.0%) | 10 (71.4%) | 5 (31.2%) | 0.067 |
| DM, n (%) | 14 (46.7%) | 7 (50.0%) | 7 (43.8%) | 1.000 |
| AHT, n (%) | 27 (90.0%) | 12 (85.7%) | 15 (93.8%) | 0.586 |
| Smoking, n (%) | 2 (6.67%) | 1 (7.14%) | 1 (6.25%) | 1.000 |
| Family history of cardiovascular disease, n (%) | 4 (13.3%) | 3 (21.4%) | 1 (6.25%) | 0.315 |
| Dyslipidemia, n (%) | 17 (56.7%) | 8 (57.1%) | 9 (56.2%) | 1.000 |
| Previous MI, n (%) | 8 (26.7%) | 5 (35.7%) | 3 (18.8%) | 0.417 |
| Previous CABG, n (%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 1.000 |
| COPD, n (%) | 2 (6.67%) | 2 (14.3%) | 0 (0.00%) | 0.209 |
| Atrial fibrillation, n (%) | 13 (43.3%) | 7 (50.0%) | 6 (37.5%) | 0.749 |
| CVA, n (%) | 2 (6.67%) | 1 (7.14%) | 1 (6.25%) | 1.000 |
| Permanent pacemaker, n (%) | 1 (3.33%) | 1 (7.14%) | 0 (0.00%) | 0.467 |
| Peripheral artery disease, n (%) | 14 (46.7%) | 7 (50.0%) | 7 (43.8%) | 1.000 |
| Initial BAV indication | 0.782 | |||
| Severe aortic stenosis | 21 (70.0%) | 11 (78.6%) | 10 (62.5%) | |
| Severe aortic stenosis + acute heart failure | 7 (23.3%) | 3 (21.4%) | 4 (25.0%) | |
| Severe aortic stenosis + cardiogenic shock | 2 (6.66%) | 0 (0.00%) | 2 (12.5%) | |
| Repeat BAV | 1 (3.33%) | 1 (7.14%) | 0 (0.00%) | 0.467 |
Estimates accompanying the cumulative incidence analysis (Figure 2)
| Time (months) | Number at risk | TAVI, % | Death, % | Alive without TAVI, % |
|---|---|---|---|---|
| 1 | 30 | 0.0 (0.0-0.0) | 0.0 (0.0-0.0) | 100 (100-100) |
| 2 | 26 | 10.0 (2.5-23.9) | 3.3 (0.2-14.8) | 83.7 (75.3-99.7) |
| 3 | 22 | 20.0 (7.9-36.0) | 6.7 (1.1-19.4) | 73.3 (59.1-91.0) |
| 4 | 19 | 30.0 (14.7-46.9) | 6.7 (1.1-19.4) | 63.3 (48.2-83.2) |
| 5 | 16 | 40.0 (22.4-57.0) | 6.7 (1.1-19.4) | 53.3 (38.2-74.5) |
| 10 | 11 | 50.0 (30.8-66.5) | 13.3 (4.0-28.3) | 36.7 (22.9-58.7) |
| 15 | 10 | 50.0 (30.8-66.5) | 16.7 (5.8-32.3) | 33.3 (20.1-55.3) |
| 20 | 9 | 50.0 (30.8-66.5) | 20.0 (7.8-36.2) | 30.0 (17.4-51.8) |
| 25 | 3 | 50.0 (30.8-66.5) | 20.0 (7.8-36.2) | 30.0 (17.4-51.8) |