Skip to main content
SpringerLink
Log in

The effect of multiple-inflation balloon aortic valvuloplasty

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Recent improvements of balloon aortic valvuloplasty (BAV) devices and procedures have provided improved outcomes, but it is not clear whether the multiple-inflation BAV technique is effective in patients with symptomatic severe aortic valve stenosis (AS). We conducted an analysis of the impact of multiple-inflation BAV (at least 6 times inflation) on the mean aortic valve area (AVA) and mean aortic valve pressure gradient (AV-PG) in patients with symptomatic severe aortic stenosis as compared with conventional BAV (from single to three times inflation). We identified two studies of multiple-inflation BAV with antegrade approach using Inoue-balloon catheter (425 patients) and four studies of conventional BAV (170 patients) with retrograde approach. Using a random intercept model, we found that multiple-inflation BAV significantly increased mean AVA (mean difference (MD) [95% indicates confidence interval (CI)] = 0.25 [0.16–0.34], P < 0.001) and significantly decreased mean AV-PG (MD [95% CI] =  − 20.2 [− 27.8, − 12.70], P < 0.001) as compared with the conventional BAV. Furthermore, despite an extremely high Society of Thoracic Surgeons (STS) score (9.2–14.5), the all-cause mortality rate at one year of multiple-inflation BAV was 16–17%. The results of our analyses indicate that the multiple-inflation BAV technique seem to be effective for patients with symptomatic severe AS as compared with conventional BAV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AS:

Aortic valve stenosis

AVA:

Aortic valve area

AV-PG:

Aortic valve pressure gradient

BAV:

Balloon aortic valvuloplasty

CI:

Indicates confidence interval

MD:

Mean difference

NYHA:

New York Heart Association

STS:

Society of Thoracic Surgeons

TAVI:

Transcatheter aortic valve implantation

References

  1. Shishido K, Yamanaka F, Ochiai T, Yamabe T, Noguchi K, Ota T, Koide Y, Ogino H, Tanaka Y, Saito S (2019) Hemodynamic comparison of CoreValve and SAPIEN-XT TAVI valves in Japanese patients. Heart Vessels 34:1674–1683

    Article  Google Scholar 

  2. Yamawaki M, Iwasaki K, Araki M, Ito T, Ito Y, Tada N, Takagi K, Yamanaka F, Watanabe Y, Yamamoto M, Shirai S, Hayashida K, Registry O-T (2018) A proctoring system to manage the learning curve associated with the introduction of transcatheter aortic valve implantation in Japan. Heart Vessels 33:630–639

    Article  Google Scholar 

  3. Cid-Menendez A, Lopez-Otero D, Gonzalez-Ferreiro R, Iglesias-Alvarez D, Alvarez-Rodriguez L, Antunez-Muinos PJ, Cid-Alvarez B, Sanmartin-Pena X, Trillo-Nouche R, Gonzalez-Juanatey JR (2019) Predictors and outcomes of heart failure after transcatheter aortic valve implantation using a self-expanding prosthesis. Rev Esp Cardiol (Engl Ed). https://doi.org/10.1016/j.rec.2019.06.006

    Article  Google Scholar 

  4. Van Mieghem NM, van der Boon RM, Nuis RJ, Schultz C, van Geuns RJ, Serruys PW, Kappetein AP, van Domburg RT, de Jaegere PP (2014) Cause of death after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 83:E277–282

    Article  Google Scholar 

  5. Calicchio F, Guarracino F, Giannini C, De Caro F, Baldassarri R, De Carlo M, Petronio AS (2017) Balloon aortic valvuloplasty before noncardiac surgery in severe aortic stenosis: a single-center experience. J Cardiovasc Med (Hagerstown) 18:109–113

    Article  Google Scholar 

  6. Mizutani K, Hara M, Ishikawa H, Nishimura S, Ito A, Iwata S, Takahashi Y, Sugioka K, Murakami T, Shibata T, Yoshiyama M (2017) Safety and efficacy of simultaneous biplane mode of 3-dimensional transesophageal echocardiography-guided antegrade multiple-inflation balloon aortic valvuloplasty in patients with severe aortic stenosis. Circ J 81:748–754

    Article  Google Scholar 

  7. Sakata Y, Matsubara K, Tamiya S, Hayama Y, Usui K (2015) The efficacy and safety of antegrade inoue-balloon aortic valvuloplasty to treat calcific critical aortic stenosis. J Invasive Cardiol 27:373–380

    PubMed  Google Scholar 

  8. O'Neill WW (1991) Predictors of long-term survival after percutaneous aortic valvuloplasty: report of the Mansfield Scientific Balloon Aortic Valvuloplasty Registry. J Am Coll Cardiol 17:193–198

    Article  CAS  Google Scholar 

  9. Fukuta H, Goto T, Wakami K, Ohte N (2017) Effects of catheter-based renal denervation on heart failure with reduced ejection fraction: a systematic review and meta-analysis. Heart Fail Rev 22:657–664

    Article  Google Scholar 

  10. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S, Investigators PT (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597–1607

    Article  CAS  Google Scholar 

  11. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ, Investigators PT (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364:2187–2198

    Article  CAS  Google Scholar 

  12. Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, Webb JG, Douglas PS, Anderson WN, Blackstone EH, Kodali SK, Makkar RR, Fontana GP, Kapadia S, Bavaria J, Hahn RT, Thourani VH, Babaliaros V, Pichard A, Herrmann HC, Brown DL, Williams M, Akin J, Davidson MJ, Svensson LG, Investigators PT (2015) 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 385:2477–2484

    Article  Google Scholar 

  13. Bosmans JM, Kefer J, De Bruyne B, Herijgers P, Dubois C, Legrand V, Verheye S, Rodrigus I, Belgian TRP (2011) Procedural, 30-day and one year outcome following CoreValve or Edwards transcatheter aortic valve implantation: results of the Belgian national registry. Interact Cardiovasc Thorac Surg 12:762–767

    Article  Google Scholar 

  14. Bleiziffer S, Mazzitelli D, Opitz A, Hettich I, Ruge H, Piazza N, Lange R (2012) Beyond the short-term: clinical outcome and valve performance 2 years after transcatheter aortic valve implantation in 227 patients. J Thorac Cardiovasc Surg 143:310–317

    Article  Google Scholar 

  15. Egenrieder S, Hill S, Backes M, Vohringer M, Sechtem U (2014) Contained aortic annulus rupture with persisting false aneurysm after transfemoral transcatheter aortic valve implantation. Clin Res Cardiol 103:599–601

    Article  Google Scholar 

  16. Thomas M, Schymik G, Walther T, Himbert D, Lefevre T, Treede H, Eggebrecht H, Rubino P, Michev I, Lange R, Anderson WN, Wendler O (2010) Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) Registry: a European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation 122:62–69

    Article  Google Scholar 

  17. Ussia GP, Barbanti M, Petronio AS, Tarantini G, Ettori F, Colombo A, Violini R, Ramondo A, Santoro G, Klugmann S, Bedogni F, Maisano F, Marzocchi A, Poli A, De Carlo M, Napodano M, Fiorina C, De Marco F, Antoniucci D, de Cillis E, Capodanno D, Tamburino C, CoreValve Italian Registry I (2012) Transcatheter aortic valve implantation: 3-year outcomes of self-expanding CoreValve prosthesis. Eur Heart J 33:969–976

    Article  Google Scholar 

  18. Feldman T, Guerrero M (2017) Balloon aortic valvuloplasty in the TAVR era: not so new but definitely improved. Catheter Cardiovasc Interv 90:311–312

    Article  Google Scholar 

  19. Eles GR, Fisher DL, Khalil R, Dajani Z, Spotti JP, Lasorda D (2011) Balloon aortic valvuloplasty for aortic stenosis using a novel percutaneous dilation catheter and power injector. J Interv Cardiol 24:92–98

    Article  Google Scholar 

  20. Kitahara H, Waseda K, Yamada R, Otagiri K, Tanaka S, Kobayashi Y, Okada K, Kume T, Nakagawa K, Teramoto T, Ikeno F, Yock PG, Fitzgerald PJ, Honda Y (2016) Acute stent recoil and optimal balloon inflation strategy: an experimental study using real-time optical coherence tomography. EuroIntervention 12:e190–198

    Article  Google Scholar 

  21. Gajanana D, Wheeler D, Hsi D, Kovach R, George JC (2016) Percutaneous balloon aortic valvuloplasty and clinical outcomes in severe aortic stenosis: correlation of procedural technique and efficacy. J Interv Cardiol 29:612–618

    Article  Google Scholar 

  22. Ford TJ, Nguyen K, Brassil J, Kushwaha V, Friedman D, Allan R, Pitney M, Jepson N (2018) Balloon aortic valvuloplasty in the transcatheter valve era: single centre indications and early safety data in a high risk population. Heart Lung Circ 27:595–600

    Article  Google Scholar 

  23. Daniec M, Sorysz D, Dziewierz A, Kleczynski P, Rzeszutko L, Krawczyk-Ozog A, Dudek D (2018) In-hospital and long-term outcomes of percutaneous balloon aortic valvuloplasty with concomitant percutaneous coronary intervention in patients with severe aortic stenosis. J Interv Cardiol 31:60–67

    Article  Google Scholar 

  24. Eugene M, Urena M, Abtan J, Carrasco JL, Ghodbane W, Nataf P, Vahanian A, Himbert D (2018) Effectiveness of rescue percutaneous balloon aortic valvuloplasty in patients with severe aortic stenosis and acute heart failure. Am J Cardiol 121:746–750

    Article  Google Scholar 

  25. Ben-Dor I, Pichard AD, Satler LF, Goldstein SA, Syed AI, Gaglia MA Jr, Weissman G, Maluenda G, Gonzalez MA, Wakabayashi K, Collins SD, Torguson R, Okubagzi P, Xue Z, Kent KM, Lindsay J, Waksman R (2010) Complications and outcome of balloon aortic valvuloplasty in high-risk or inoperable patients. JACC Cardiovasc Interv 3:1150–1156

    Article  Google Scholar 

  26. Uddin A, Fairbairn TA, Djoukhader IK, Igra M, Kidambi A, Motwani M, Herzog B, Ripley DP, Musa TA, Goddard AJ, Blackman DJ, Plein S, Greenwood JP (2015) Consequence of cerebral embolism after transcatheter aortic valve implantation compared with contemporary surgical aortic valve replacement: effect on health-related quality of life. Circ Cardiovasc Interv 8:e001913

    Article  Google Scholar 

  27. Van Belle E, Hengstenberg C, Lefevre T, Kupatt C, Debry N, Husser O, Pontana F, Kuchcinski G, Deliargyris EN, Mehran R, Bernstein D, Anthopoulos P, Dangas GD, Investigators B-MS (2016) Cerebral embolism during transcatheter aortic valve replacement: the BRAVO-3 MRI study. J Am Coll Cardiol 68:589–599

    Article  Google Scholar 

Download references

Funding

This study was carried out with no external funding.

Author information

Authors and Affiliations

  1. Clinical and Translational Research Center, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Akihide Konishi & Takashi Omori

  2. Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Hyogo, Japan

    Masamichi Iwasaki

  3. Division of Cardiovascular Medicine, Department of Internal Medicine, Showa University Graduate School of Medicine, Tokyo, Japan

    Toshiro Shinke

Authors
  1. Akihide Konishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masamichi Iwasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takashi Omori
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Toshiro Shinke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Akihide Konishi.

Ethics declarations

Conflict of interest

There are no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Konishi, A., Iwasaki, M., Omori, T. et al. The effect of multiple-inflation balloon aortic valvuloplasty. Heart Vessels 35, 1557–1562 (2020). https://doi.org/10.1007/s00380-020-01626-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-020-01626-9

Keywords

Search

Navigation