Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis： a new paradigm for the heart team decision making

BackgroundWhilst 有严重大动脉的狭窄的病人的多数能直接针对外科的大动脉的阀门代替(AVR ) 或 transcatheter 大动脉的阀门培植(TAVI ) ，在一些例子，另外的信息可以被需要完成诊断体育锻练。我们评估了汽球的角色大动脉的 valvuloplasty (BAV ) 作为在选择高风险的 patients.MethodsBetween 的 bridge-to-decision (BTD ) 2007 和 2012，在我们的机构的心队在 202 个病人要求了 BTD BAV。很低的左室的喷射部分，僧帽形的流回等级 &#x02265；3，这些因素的脆弱，血液动力学的不稳定性，严肃的 comorbidity，或联合是为这策略的主要司机。我们评估了 BAV 怎么在整个耐心的组并且在为心脏的起作用的风险评估(EuroSCORE ) 的逻辑欧洲系统是的各特定的 subgroup.ResultsMean 影响了最后的治疗策略 23.5%&#x000b1；15.3% ，年龄 81 &#x000b1；7 年。在里面医院死亡是 4.5% ，脑血管的事故 1% 并且全面脉管的复杂并发症 4%(0.5% 专业；3.5% 未成年者) 。熬过并且收到第二心队评估的有 BTD BAV 的 193 个病人， 72.6% 最后被认为为权威的治疗合格(25.4% 为 AVR；47.2% 为 TAVI ) ：有左室的喷射部分恢复的 96.7% 病人；有僧帽形的流回减小的 70.5% 病人；在临床的血液动力学的不稳定性经历了 BAV 的 75.7% 病人；69.2% 脆弱的病人和不能是权威的 transcatheter 或外科的治疗的立即的候选人的介绍了大动脉的 valvuloplasty 能与严重大动脉的狭窄在高风险的病人被看作 bridge-to-decision 的严肃的 comorbidities.ConclusionsBalloon 的 68% 病人。

Background Whilst the majority of the patients with severe aortic stenosis can be directly addressed to surgical aortic valve replace- ment （AVR） or transcatheter aortic valve implantation （TAVI）, in some instances additional information may be needed to complete the diagnostic workout. We evaluated the role of balloon aortic valvuloplasty （BAV） as a bridge-to-decision （BTD） in selected high-risk patients. Methods Between 2007 and 2012, the heart team in our Institution required BTD BAV in 202 patients. Very low left ventricular ejection fraction, mitral regurgitation grade 〉 3, frailty, hemodynamic instability, serious comorbidity, or a combination of these factors were the main drivers for this strategy. We evaluated how BAV influenced the final treatment strategy in the whole patient group and in each specific subgroup. Results Mean logistic European System for Cardiac Operative Risk Evaluation （EuroSCORE） was 23.5%±15.3%, age 81 ± 7 years. In-hospital mortality was 4.5%, cerebrovascular accident 1% and overall vascular complications 4% （0.5% major; 3.5% minor）. Of the 193 patients with BTD BAV who survived and received a second heart team evaluation, 72.6% were finally deemed eligible for definitive treatment （25.4% for AVR; 47.2% for TAVI）： 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented serious comorbidities. Conclusions Balloon aortic valvuloplasty can be considered as bridge-to- decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive transcatheter or surgical treatment.