Outcome of patients undergoing transcatheter aortic valve implantation after prior balloon aortic valvuloplasty

OBJECTIVES: Transcatheter aortic valve implantation (TAVI) is an effective treatment for severe aortic stenosis. Yet, balloon aortic valvuloplasty (BAV) is still occasionally offered to apparently inoperable patients as bridge or destination therapy, with some eventually receiving TAVI. We aimed to determine whether prior BAV would unfavorably impact TAVI. METHODS: The RISPEVA dataset was analyzed to compare the outcomes of non-BAV subjects undergoing TAVI vs those with prior BAV. Outcomes of interest were procedural results, hospital stay, and in-hospital outcomes, including major adverse events. Unadjusted and propensity-matched analyses were performed. RESULTS: A total of 1683 patients were included (1541 [91.6%] non-BAV and 142 [8.4%] prior BAV). Device success, procedural success, major adverse events and their individual components were all similar in the two groups, in both unadjusted and propensity-matched analyses. However, non-BAV patients had significantly shorter intensive/coronary care unit stay (8.1 ± 23.0 days vs 13.4 ± 35.2 days; P≤.03) and total hospital stay (12.4 ± 22.1 days vs 17.2 ± 32.7 days; P≤.02). Similar findings were obtained even in the propensity-matched groups (6.3 ± 11.9 days vs 13.6 ± 35.5 days [P≤.05] and 10.5 ± 13.8 days vs 17.4 ± 33.1 days [P≤.03], respectively). No significant interaction was found between device type and prior BAV status. CONCLUSION: BAV continues to offer a palliative solution to patients with unclear or poor prognosis and deemed at too high risk for emergent TAVI or surgery. Subjects undergoing BAV and surviving the post-BAV period can undergo TAVI without a significantly increased risk of in-hospital adverse events in comparison with non-BAV patients.