The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Balloon Aortic Valvuloplasty for Severe Aortic Stenosis Before Urgent Noncardiac Surgery

DOI: 10.4244/EIJ-D-20-01423

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 center, Faculté libre de médecine/université catholique de Lille, F-59000 Lille, France
3. Univ. Lille, CHU Lille, EA 2694-Santé publique:épidémiologie et qualité des soins of biostatistics, EA 2694 – Santé publique: épidémiologie et qualité des soins, F-59000 Lille, France
4. CHRU Lille, Institut Coeur Poumon, Cardiology Department of Interventional Cardiology for coronary, Valves and Structural Heart Diseases, Lille, France, France
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Background: Balloon aortic valvuloplasty (BAV) has been proposed as a therapeutic option in patients suffering from severe aortic stenosis (SAS) who need urgent noncardiac surgery (NCS). Whether this strategy is better than medical therapy in this very peculiar population is unknown. 
Aims: We evaluated 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 2 centers included 133 patients with SAS undergoing urgent NCS, of whom n=93 underwent preoperative BAV (IS) and n=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). The primary outcome was the MACE at 1-month follow-up after NCS including mortality, heart-failure, and other cardiovascular outcomes.
Results: 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, 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) 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 3-months survival (89.2% vs. 90.0%;IPTW-adjustedHR=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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