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Balloon Aortic Valvuloplasty

  • Chapter
Aortic Stenosis

Abstract

The role of surgical aortic valve replacement (SAVR) for aortic stenosis (AS) is well established as a lifesaving therapy, conferring improved survival, improved symptomatic status, decreases in left ventricular hypertrophy, and improvement in left ventricular systolic function. However, there remain a group of patients with clinical risk factors in whom the risk of SAVR is felt to be prohibitive due to comorbidities. Such risk factors include advanced age, advanced renal and pulmonary disease, and severe left ventricular dysfunction. Of particular concern were patients with “low gradient” AS in the presence of severe LV dysfunction and low cardiac output. The natural history of this group, treated medically, is dismal, with a 3 year survival of 25 %.

Balloon dilatation of the aortic valve in non-calcified AS in young patients has been performed since 1984 with good short and long term results. Given these results, this technique was adapted for the treatment of high risk patients with AS in the 1980s by a number of groups. The procedure enjoyed some popularity in the mid 1980s in the treatment of a group of patient who otherwise were not candidates for SAVR. Enthusiasm waned, however, with subsequent reports of almost universal early recurrence of symptoms and hemodynamic deterioration, and aortic valvuloplasty was performed relatively infrequently over the subsequent 20 years. However, in the last several years, the success of transcatheter aortic valve replacement (TAVR) has again focused attention on patients who were felt to be at high risk for SAVR, and the role of BAV is being reassessed.

The purpose of this chapter is to review the technique of balloon aortic valvuloplasty (BAV), and its place in the current era of valve interventions.

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Correspondence to Aaron David Berman MD, FACC .

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Berman, A.D. (2015). Balloon Aortic Valvuloplasty. In: Abbas, A. (eds) Aortic Stenosis. Springer, London. https://doi.org/10.1007/978-1-4471-5242-2_13

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