Effectiveness of Rescue Percutaneous Balloon Aortic Valvuloplasty in Patients With Severe Aortic Stenosis and Acute Heart Failure
The prognosis of patients with cardiogenic shock (CS) or refractory pulmonary edema because of severe aortic stenosis remains poor. The purpose of this study was to assess the outcomes of rescue percutaneous balloon aortic valvuloplasty (PBAV) in the transcatheter aortic valve implantation (TAVI) er...
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| Veröffentlicht in: | The American journal of cardiology 2018-03, Vol.121 (6), p.746-750 |
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| creator | Eugène, Marc Urena, Marina Abtan, Jérémie Carrasco, José-Luis Ghodbane, Walid Nataf, Patrick Vahanian, Alec Himbert, Dominique |
| description | The prognosis of patients with cardiogenic shock (CS) or refractory pulmonary edema because of severe aortic stenosis remains poor. The purpose of this study was to assess the outcomes of rescue percutaneous balloon aortic valvuloplasty (PBAV) in the transcatheter aortic valve implantation (TAVI) era. Patients were consecutively included between 2008 and 2016. CS was defined as ≥1 sign of systemic hypoperfusion and need of catecholamines. Refractory pulmonary edema was defined as not controlled by optimal medical treatment. A total of 40 patients, 22 men (55%), aged 79 ± 9 years, were included: 17 with CS (42.5%), 23 with refractory pulmonary edema (57.5%). After PBAV, mean transaortic gradient decreased from 47 ± 16 mm Hg to 32 ± 10 mm Hg (p |
| doi_str_mv | 10.1016/j.amjcard.2017.11.048 |
| format | Article |
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The purpose of this study was to assess the outcomes of rescue percutaneous balloon aortic valvuloplasty (PBAV) in the transcatheter aortic valve implantation (TAVI) era. Patients were consecutively included between 2008 and 2016. CS was defined as ≥1 sign of systemic hypoperfusion and need of catecholamines. Refractory pulmonary edema was defined as not controlled by optimal medical treatment. A total of 40 patients, 22 men (55%), aged 79 ± 9 years, were included: 17 with CS (42.5%), 23 with refractory pulmonary edema (57.5%). After PBAV, mean transaortic gradient decreased from 47 ± 16 mm Hg to 32 ± 10 mm Hg (p < 0.001), aortic valve area increased from 0.60 ± 0.18 cm2 to 0.88 ± 0.22 cm2 (p < 0.0001), left ventricular ejection fraction increased from 35 ± 15 to 37 ± 14% (p = 0.02), and systolic pulmonary artery pressure decreased from 61 ± 15 to 48 ± 12 mm Hg (p = 0.002). There was no procedural death. Early death occurred in 12 patients (30%). After PBAV, 16 of the 28 survivors (57%) were bridged to surgical aortic valve replacement (SAVR; n = 7) or TAVI (n = 9), and 12 (43%) were denied definitive therapy. The 2-year estimated survival rate was 71 ± 17% after SAVR, 36 ± 19% after TAVI, and 8 ± 8% after PBAV alone. In conclusion, rescue PBAV is safe in patients with CS and high-risk aortic stenosis or refractory pulmonary edema and may improve their dismal prognosis when followed by TAVI or SAVR.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2017.11.048</identifier><identifier>PMID: 29397882</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aortic stenosis ; Aortic valve ; Balloon treatment ; Blood pressure ; Cardiovascular disease ; Catecholamines ; Coronary vessels ; Edema ; Electrocardiography ; Heart ; Heart diseases ; Heart failure ; Heart surgery ; Implantation ; Medical treatment ; Mercury ; Patients ; Prognosis ; Pulmonary arteries ; Pulmonary artery ; Stenosis ; Surgery ; Ventilators ; Ventricle</subject><ispartof>The American journal of cardiology, 2018-03, Vol.121 (6), p.746-750</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>2017. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-55a905a1ea438dc81cdd4d5f0dfaa4c235e14afe22a626c2eb0ab77dd579b61a3</citedby><cites>FETCH-LOGICAL-c393t-55a905a1ea438dc81cdd4d5f0dfaa4c235e14afe22a626c2eb0ab77dd579b61a3</cites><orcidid>0000-0002-0336-0058</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914917319288$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29397882$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eugène, Marc</creatorcontrib><creatorcontrib>Urena, Marina</creatorcontrib><creatorcontrib>Abtan, Jérémie</creatorcontrib><creatorcontrib>Carrasco, José-Luis</creatorcontrib><creatorcontrib>Ghodbane, Walid</creatorcontrib><creatorcontrib>Nataf, Patrick</creatorcontrib><creatorcontrib>Vahanian, Alec</creatorcontrib><creatorcontrib>Himbert, Dominique</creatorcontrib><title>Effectiveness of Rescue Percutaneous Balloon Aortic Valvuloplasty in Patients With Severe Aortic Stenosis and Acute Heart Failure</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>The prognosis of patients with cardiogenic shock (CS) or refractory pulmonary edema because of severe aortic stenosis remains poor. The purpose of this study was to assess the outcomes of rescue percutaneous balloon aortic valvuloplasty (PBAV) in the transcatheter aortic valve implantation (TAVI) era. Patients were consecutively included between 2008 and 2016. CS was defined as ≥1 sign of systemic hypoperfusion and need of catecholamines. Refractory pulmonary edema was defined as not controlled by optimal medical treatment. A total of 40 patients, 22 men (55%), aged 79 ± 9 years, were included: 17 with CS (42.5%), 23 with refractory pulmonary edema (57.5%). After PBAV, mean transaortic gradient decreased from 47 ± 16 mm Hg to 32 ± 10 mm Hg (p < 0.001), aortic valve area increased from 0.60 ± 0.18 cm2 to 0.88 ± 0.22 cm2 (p < 0.0001), left ventricular ejection fraction increased from 35 ± 15 to 37 ± 14% (p = 0.02), and systolic pulmonary artery pressure decreased from 61 ± 15 to 48 ± 12 mm Hg (p = 0.002). There was no procedural death. Early death occurred in 12 patients (30%). After PBAV, 16 of the 28 survivors (57%) were bridged to surgical aortic valve replacement (SAVR; n = 7) or TAVI (n = 9), and 12 (43%) were denied definitive therapy. The 2-year estimated survival rate was 71 ± 17% after SAVR, 36 ± 19% after TAVI, and 8 ± 8% after PBAV alone. In conclusion, rescue PBAV is safe in patients with CS and high-risk aortic stenosis or refractory pulmonary edema and may improve their dismal prognosis when followed by TAVI or SAVR.</description><subject>Aortic stenosis</subject><subject>Aortic valve</subject><subject>Balloon treatment</subject><subject>Blood pressure</subject><subject>Cardiovascular disease</subject><subject>Catecholamines</subject><subject>Coronary vessels</subject><subject>Edema</subject><subject>Electrocardiography</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Heart failure</subject><subject>Heart surgery</subject><subject>Implantation</subject><subject>Medical treatment</subject><subject>Mercury</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Pulmonary arteries</subject><subject>Pulmonary artery</subject><subject>Stenosis</subject><subject>Surgery</subject><subject>Ventilators</subject><subject>Ventricle</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU1v1DAQhiMEokvhJ4AsceGS4HHiJD6hbdUvqRIV5eNozdoT4SgbL7azUo_8c1ztlgMXTtZIz7zjmaco3gKvgEP7caxwOxoMthIcugqg4k3_rFhB36kSFNTPixXnXJQKGnVSvIpxzCWAbF8WJ0LVqut7sSp-XwwDmeT2NFOMzA_sC0WzELujYJaEM_klsjOcJu9ntvYhOcO-47RfJr-bMKYH5mZ2h8nRnCL74dJPdk97CvQE3yeafXSR4WzZOmcSuyYMiV2im5ZAr4sXA06R3hzf0-Lb5cXX8-vy9vPVzfn6tjS1qlMpJSouEQiburemB2NtY-XA7YDYGFFLggYHEgJb0RpBG46brrNWdmrTAtanxYdD7i74XwvFpLcuGpqmw44alGrqVjQ9ZPT9P-jolzDn32nBeSfrRrZdpuSBMsHHGGjQu-C2GB40cP3oSI_66Eg_OtIAOjvKfe-O6ctmS_Zv15OUDHw6AJTPsXcUdDT5vIasC9mVtt79Z8Qf2VinNg</recordid><startdate>20180315</startdate><enddate>20180315</enddate><creator>Eugène, Marc</creator><creator>Urena, Marina</creator><creator>Abtan, Jérémie</creator><creator>Carrasco, José-Luis</creator><creator>Ghodbane, Walid</creator><creator>Nataf, Patrick</creator><creator>Vahanian, Alec</creator><creator>Himbert, Dominique</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0336-0058</orcidid></search><sort><creationdate>20180315</creationdate><title>Effectiveness of Rescue Percutaneous Balloon Aortic Valvuloplasty in Patients With Severe Aortic Stenosis and Acute Heart Failure</title><author>Eugène, Marc ; 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The purpose of this study was to assess the outcomes of rescue percutaneous balloon aortic valvuloplasty (PBAV) in the transcatheter aortic valve implantation (TAVI) era. Patients were consecutively included between 2008 and 2016. CS was defined as ≥1 sign of systemic hypoperfusion and need of catecholamines. Refractory pulmonary edema was defined as not controlled by optimal medical treatment. A total of 40 patients, 22 men (55%), aged 79 ± 9 years, were included: 17 with CS (42.5%), 23 with refractory pulmonary edema (57.5%). After PBAV, mean transaortic gradient decreased from 47 ± 16 mm Hg to 32 ± 10 mm Hg (p < 0.001), aortic valve area increased from 0.60 ± 0.18 cm2 to 0.88 ± 0.22 cm2 (p < 0.0001), left ventricular ejection fraction increased from 35 ± 15 to 37 ± 14% (p = 0.02), and systolic pulmonary artery pressure decreased from 61 ± 15 to 48 ± 12 mm Hg (p = 0.002). There was no procedural death. Early death occurred in 12 patients (30%). After PBAV, 16 of the 28 survivors (57%) were bridged to surgical aortic valve replacement (SAVR; n = 7) or TAVI (n = 9), and 12 (43%) were denied definitive therapy. The 2-year estimated survival rate was 71 ± 17% after SAVR, 36 ± 19% after TAVI, and 8 ± 8% after PBAV alone. In conclusion, rescue PBAV is safe in patients with CS and high-risk aortic stenosis or refractory pulmonary edema and may improve their dismal prognosis when followed by TAVI or SAVR.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29397882</pmid><doi>10.1016/j.amjcard.2017.11.048</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-0336-0058</orcidid></addata></record> |
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| source | Elsevier ScienceDirect Journals Complete |
| subjects | Aortic stenosis Aortic valve Balloon treatment Blood pressure Cardiovascular disease Catecholamines Coronary vessels Edema Electrocardiography Heart Heart diseases Heart failure Heart surgery Implantation Medical treatment Mercury Patients Prognosis Pulmonary arteries Pulmonary artery Stenosis Surgery Ventilators Ventricle |
| title | Effectiveness of Rescue Percutaneous Balloon Aortic Valvuloplasty in Patients With Severe Aortic Stenosis and Acute Heart Failure |
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