Balloon aortic valvuloplasty: current status and future prospects

ABSTRACT

Introduction

Balloon aortic valvuloplasty (BAV) improves hemodynamic and clinical status of patients with severe aortic stenosis (AS) for a limited period of 6–12 months. However, there is a high number of procedures performed worldwide and an upward trend over the last decades.

Areas covered

Epidemiology of AS and the advent of transcatheter aortic valve implantation (TAVI) contribute to the extensive referral of patients. The expansion of recommendations for TAVI has occasionally led to financial reimbursement-related problems that do not exist for BAV. BAV is indicated as a bridge to valve replacement, to decision in complex cases, and to extracardiac surgery. BAV may play a role in preparing for TAVI and optimizing procedural results. The minimalist approach and reduced complication rate make it applicable in fragile patients.

Expert opinion

In the near future, BAV will continue to be a useful asset in managing patients with AS given the multiple indications, broad applicability, safety profile, low cost, and repeatability. Specific studies are necessary to explore technical solutions, stronger indications, the finest technique, and to standardize the procedural result. Pending the development of potential competitive devices, the role that BAV plays will remain closely intertwined with the one played by TAVI.

KEYWORDS:

• Aortic stenosis
• balloon aortic valvuloplasty
• complication
• minimalist approach
• transcatheter aortic valve implantation

Article highlights

• BAV is currently used in a significant proportion of patients with aortic stenosis as a bridge to valve replacement, non-cardiac surgery, or decision on the most appropriate treatment in unstable or complex patients.

• BAV may be superior to medical therapy alone in improving short-term survival and quality of life in patients excluded from valve replacement.

• The complication rate is lower than in past series, as a result of refined techniques and improved operator skills, which allow for a minimalist approach.

• BAV interacts closely with TAVI since a minority of patients may require balloon predilatation or postdilatation, depending on anatomic or procedural complexity.

• Bioprosthetic valve fracture added to valve-in-valve TAVI means optimized hemodynamics and a higher procedural success rate.

• The future of BAV will depend on TAVI availability and the development of alternative devices.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.