Immediate benefit of balloon aortic valvuloplasty in severe aortic stenosis: hemodynamic echographic assessment in Intensive Coronary Care Unit

Abstract

Background : Balloon aortic valvuloplasty (BAV) might be a life saving procedure in critically advanced aortic stenosis (AS) as a bridge therapy to surgical aortic valve replacement (AVR) or to trans-catheter aortic heart valve (TAVI), by reducing trans-aortic gradient and increasing aortic valve area (AVA). Few is known on the benefit of BAV on cardiac output. Our study proposed to evaluate the hemodynamic changes after BAV by transthoracic echocardiography (TTE). Methods: 30 consecutive patients with AS undergoing BAV were prospectively included between July 2014 and July 2015. Hemodynamic assessment was performed pre- and post-BAV by TTE. Low cardiac output (CO) was defined by a cardiac index (CI) < 2.5 L/min/m 2 . Results: Mean age was 82 ± 8 years; 56.7% were female; mean logistic EuroSCORE I was 31 ± 19 %. 20 patients (67%) had low CO. TTE showed that the patients with low CO improved AVA (from 0.57 ± 0.2 to 1.05 ± 0.5, p=0.043), CI (from 1.9 ± 0.4 to 2.8 ± 1.0 L/min/m 2 , p<0.0001), LVEF (from 31 ± 16 to 38 ± 13%, p=0.006), tend to decrease systolic pulmonary artery pressure (sPAP) (from 52 ± 19 to 43 ± 11 mmHg, p=0.06) and to increase mean arterial pressure (MAP) (from 79 ± 10 to 83 ± 12 mmHg, p=0.046). There was no statistically significant difference in terms of hemodynamic in patients with a normal CO (CI ≥ 2.5 L/min/m 2 ). Conclusion: By increasing AVA, BAV significantly and immediately improve cardiac output especially in patients with low CO at baseline.