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

• Published in: EuroIntervention Vol. 17; no. 8; p. e680
• Main Authors: Debry, Nicolas, Altes, Alexandre, Vincent, Flavien, Delhaye, Cédric, Schurtz, Guillaume, Nedjari, Farid, Legros, Gabin, Porouchani, Sina, Coisne, Augustin, Richardson, Marjorie, Cosenza, Alessandro, Verdier, Basile, Denimal, Tom, Pamart, Thibault, Spillemaeker, Hugues, Sylla, Habib, Sudre, Arnaud, Janah, Dany, Aouate, David, Marsou, Wassima, Appert, Ludovic, Lemesle, Gilles, Labreuche, Julien, Maréchaux, Sylvestre, Van Belle, Eric
• Format: Journal Article
• Language: English
• Published: France EuroPCR 01-10-2021
• Subjects: Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Balloon Valvuloplasty; Humans; Life Sciences; Retrospective Studies; Risk Factors; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome
• ISSN: 1774-024X; 1969-6213
• DOI: 10.4244/EIJ-D-20-01423

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