Modified balloon aortic valvuloplasty in fragile symptomatic patients unsuitable for both surgical and percutaneous valve replacement

Abstract Background Balloon Aortic valvuloplasty (BAV) is considered as a bridge therapy to percutaneous valve implantation or a palliative treatment in patients with aortic valve stenosis (AVS). Potential risk of complications, in particular in fragile patients, is still not negligible. Aim To describe the technique and outcomes of modified BAV in fragile symptomatic patients unsuitable for other treatments using no-pacing and minimally invasive approach. Methods Symptomatic fragile patients with severe aortic valve stenosis judged unsuitable by the heart team for surgical or percutaneous valve implantation from 1 September 2013 to 1 September 2017 were offered modified BAV. Simplified procedural protocol included a 4F right radial artery access for gradient check, a 8F compatible undersized balloons, two partial inflations-trial before a full inflation with no-pace maker back-up, final pressure gradient recording and aortography. Results Thirty-four symptomatic fragile patients (mean age 80.9 ± 4.9, range 73 to 91 years, 100% Katz > 6, mean Euroscore I 30.0 ± 11.7%) underwent modified BAV in the last 5 years with immediate success in all (100%). Mean aortic valve area increased from 0.58 ± 0.2 cm 2 to 1.1 ± 0.2 cm 2 ( p p Conclusions No-pacing minimally invasive BAV seems to have acceptable outcomes in patients with severe AVS and no other treatment options.