Interventions for valvular disease and heart failure

Balloon aortic valvuloplasty for severe aortic stenosis before urgent non-cardiac surgery

EuroIntervention 2021;17:e680-e687. DOI: 10.4244/EIJ-D-20-01423

Nicolas Debry
Nicolas Debry1,2,3, MD; Alexandre Altes2, MD; Flavien Vincent1,3,4, MD, PhD; Cédric Delhaye1, MD; Guillaume Schurtz1, MD; Farid Nedjari2, MD; Gabin Legros2, MD; Sina Porouchani1, MD; Augustin Coisne3,4,5, MD, PhD; Marjorie Richardson5, MD; Alessandro Cosenza1, MD; Basile Verdier1, MD; Tom Denimal1, MD; Thibault Pamart1, MD; Hugues Spillemaeker1, MD; Habib Sylla1, MD; Arnaud Sudre1, MD; Dany Janah1, MD; David Aouate1, MD; Wassima Marsou2, MD; Ludovic Appert2, MD; Gilles Lemesle1,3,4, MD, PhD; Julien Labreuche6, BST; Sylvestre Maréchaux2, MD, PhD; Eric Van Belle1,3,4, MD, PhD
1. CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France; 2. Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL), Cardiology Department and Heart Valve Centre, Faculté Libre de Médecine/Université Catholique de Lille, Lille, France; 3. INSERM, U1011, Lille, France; 4. Université de Lille, Lille, France; 5. CHU Lille, Department of Clinical Physiology and Echocardiography, Lille, France; 6. Université de Lille, CHU Lille, Lille, France

Background: Balloon aortic valvuloplasty (BAV) has been proposed as a therapeutic option in patients suffering from severe aortic stenosis (SAS) who need urgent non-cardiac surgery (NCS). Whether this strategy is better than medical therapy in this very specific population is unknown.

Aims: We aimed to evaluate the clinical benefit of an invasive strategy (IS) with preoperative BAV in patients with SAS requiring urgent NCS.

Methods: From 2011 to 2019, a registry conducted in two centres included 133 patients with SAS undergoing urgent NCS, of whom 93 underwent preoperative BAV (IS) and 40 a conservative strategy (CS) without BAV. All analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW) (10 clinical and anatomical variables).

Results: The primary outcome was MACE at one-month follow-up after NCS including mortality, heart failure, and other cardiovascular outcomes. In patients managed conservatively, occurrence of MACE was 20.0% (n=8) and death was 10.0% (n=4) at 1 month. In patients undergoing BAV, the occurrence of MACE was 20.4% (n=19) and death was 5.4% (n=5) at 1 month. Among patients undergoing conservative management, all events were observed after NCS while, in patients undergoing BAV, 12.9% (n=12) had events between BAV and NCS including 3 deaths, and 7.5% (n=7) had events after NCS including 2 deaths. In IPTW propensity analyses, the incidence of the primary outcome (20.4% vs 20.0%; OR 0.93, 95% CI: 0.38-2.29) and three-month survival (89.2% vs 90.0%; IPTW-adjusted HR 0.90, 95% CI: 0.31-2.60) were similar in both groups.

Conclusions: Patients with SAS managed conservatively before urgent NCS are at high risk of events. A systematic invasive strategy using BAV does not provide a significant improvement in clinical outcome.

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aortic stenosisballoon aortic valvuloplastynon-cardiac surgery
Interventions for valvular diseaseOther valvular and structural interventions
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