166 Balloon aortic valvuloplasty in unstable and critically ill patients: analysis of three strategies

Aim Thanks to improved technology and the advent of transcatheter aortic valve implantation (TAVI), balloon aortic valvuloplasty (BAV) has reappared in the management of high risk patients with severe aortic stenosis in a critical clinical state in three different therapeutic strategies: 1) palliative care [A] 2) bridge to surgery [B] 3) bridge to TAVI [C]. Our main objective was to assess the safety, the effiency and the pertinence of BAV. Methods Thirty six patients with severe aortic stenosis and prohibitive surgical risk (logistic Euroscore > 15% or severe commorbidities) underwent 39 BAV: 8 in strategy A, 20 in strategy B, 11 in strategy C. 3 patients underwent a second BAV due to early restenosis. Results There was a significant improvement of the hemodynamic parameters after BAV: the peak to peak transaortic gradient was reduced by 56% (47 mmHg vs 30 mmHg; p  2 /m 2 ; p  Conclusion BAV is a safe and efficient transient therapeutic strategy for patients with severe aortic stenosis with prohibitive surgical risk. BAV appears to be more pertinent in bridge to surgery or brige to TAVI than in palliative care. For patients in critical clinical state, BAV stabilizes the hemodynamic status and allows the assessment of anatomical selection criteria for TAVI Strategy A (n = 8) Strategy B (n = 20) Strategy C (n = 11) Age (mean, min-max) 80 (61–94) 73 (44–85) 81 (60–87) Mean logistic Euroscore (%) 48 22.6 44.2 Death n (%) 6 (75) 8 (40) 5 (45) Cardiovascular death n (%) 4 (50) 3 (15) 2 (18) Time of occurrence (days, min-max) 12 (0–47) 66 (0–130) 155 (10–316) Aortic valve replacement n (%) - 14 (70) - TAVI n (%) - - 2 (18)