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Education in Heart
Valvular heart diseases
Balloon aortic valvuloplasty: indications, patient eligibility, technique and contemporary outcomes
  1. Timothy Williams,
  2. David J R Hildick-Smith
  1. Sussex Cardiac Centre, Brighton, UK
  1. Correspondence to Dr David J R Hildick-Smith, Cardiology, Sussex Cardiac Centre, Brighton BN2 5BE, UK; david.hildick-smith{at}bsuh.nhs.uk

https://doi.org/10.1136/heartjnl-2019-315904

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    Learning objectives

    • To review the indications for balloon aortic valvuloplasty (BAV) and how it fits into the treatment of aortic stenosis, and to consider which patients may benefit from the procedure.

    • To understand the technique and potential complications, including the variety of devices available.

    • To consider outcomes from the procedure and how BAV can be used in the future.

    Introduction

    Calcific, degenerative aortic stenosis (AS) is the the most common valve pathology in the ageing Western population.1 Prevalence increases with age, from 0.2% in those aged 50–59 years to 9.8% among those aged 80–89 years.2 AS is gradually progressive and can ultimately be fatal. Symptoms develop as the condition deteriorates, to the point where intervention is required either for symptoms, for prognosis or both.

    The underlying pathology of senile, degenerative AS is an active inflammatory process akin to atherosclerotic vascular disease. Definitive treatments for AS include surgical valve replacement (sAVR) or transcatheter aortic valve implantation (TAVI). Both of these techniques are well proven and prominent in guidelines3 but are not suitable for all patients.

    Balloon aortic valvuloplasty (BAV) has been in existence for over 30 years.4 After the initial enthusiasm was tempered by the finding of early restenosis, the treatment is often reserved for patients who are not physically strong enough to withstand more definitive therapy. Numbers of BAV procedures have increased with the widespread adoption and availability of TAVI.5 This article aims to discuss the role of BAV in current guidelines, which patients are most suitable for the procedure, how it is performed, and what outcomes and complications may be anticipated.

    How does BAV fit into the guidelines?

    Current European guidelines state that BAV has a IIb (level of evidence class C) indication for patients with haemodynamic instability as a bridge therapy to definitive treatment with either sAVR or TAVI,3 as a treatment …

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    Footnotes

    • Contributors The authors contributed equally to the production of this work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Data availability statement There are no data in this work

    • Author note References which include a * are considered to be key references