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Prior to the development of transcatheter aortic valve replacement (TAVR), balloon aortic valvuloplasty (BAV) had very limited indications in patients with severe aortic stenosis due to risks of complications, lack of durability, and little to no impact on long-term survival. However, up to 75% evaluated for TAVR are ineligible at the time of referral. Thus, many of these patients can potentially benefit from BAV as a bridge to TAVR.
We aimed to perform a systematic review of the literature of efficacy and safety outcomes of BAV as a bridge to TAVR. PubMed and EMBASE were searched for studies that reported the outcomes of interest following BAV with intention-to-bridge for TAVR. Baseline demographic data from studies were collected, and a pooled analysis of outcomes was calculated amongst all studies that met inclusion criteria.
A total of 5 studies and 950 procedures were included. The average patient age ranged from 78.1 to 83.2 years, and 49.1% were men. The mean logistic EuroSCORE ranged from 21.5 to 46.9. STS score ranged between 10 ± 8 to 22 ± 12. Periprocedural complications included acute kidney injury (9.9%; 48/482); major bleeding (4.7%; 23/482); major vascular complications (2.8%; 18/630); severe aortic regurgitation (1.6%; 7/427); and permanent pacemaker implantation (1.5%; 7/468). Stroke (1.1%; 10/909) and myocardial infarction (0.4%; 3/805) were rare complications. All-cause and CV mortality were 4.4% (37/846) and 4.2% (29/684), respectively. In a median follow-up that ranged from 10 to 20 months, 368 (38.7%) and 46 (4.8%) patients underwent TAVR and SAVR, respectively. During follow-up, all-cause mortality was 36% in the overall cohort, whereas it was 19.4% in a 2-year follow-up of patients that underwent TAVR.
This systematic review of BAV in the TAVR-era demonstrates safety of the procedure, with a very low incidence of periprocedural mortality and stroke. Survival of intention-to-bridge BAV beyond one year remains poor. Less than 50% of patients who have intention-to-bridge BAV actually undergo aortic valve replacement during follow-up. These patients have a significantly lower mortality when compared to destination-therapy BAV.