Antegrade Aortic Balloon Valvuloplasty By Inoue Balloon As An Alternative Approach
Kosuke Fujii, Toshihiko Saga, Masahiko Onoe, Toshio Kaneda, Susumu Nakamoto.
Kindai University, Osaka, Japan.
OBJECTIVE: SAVR and TAVR are usually performed in aortic valve stenosis. However cardiopulmonary bypass, or unstuitable anatomical condition are more invasive approaches used for high-risk patients such as the elderly or those who have severe pulmonary insufficiency or sever atherosclerotic lesions. At our institution, high-risk patients underwent antegrade transseptal aortic balloon aortic valvuloplasty (BAV) with an Inoue balloon catheter. In this study, we have investigated the results and report the effectiveness of this approach.
METHODS: From July 2011, 25 consecutive patients underwent antegrade transseptal BAV using an Inoue balloon. The study group was characterized by their advanced age (mean 80.73.7. years). Logistic Euro Score 2 was 23.62, , STS Score was 19.23. The mean follow-up was 17 months. Five patients required hemodialysis. A 14-Fr sheath was placed in the femoral vein and the left atrium was accessed from the femoral vein with an 8-Fr sheath that was passed through the 14-Fr sheath using a standard transseptal puncture technique under intra-cardiac echo or TEE. In the distal abdominal or descending aorta, an extra stiff wire was snared and secured in place via the femoral artery sheath, providing adequate support to advance the Inoue balloon from the femoral vein. The Inoue balloon was inflated 10-20 times across the aortic valve depending on the aortic annural size.
RESULTS: There were three in-hospital deaths (one after aortic valve replacement surgery and two due to heart failure). Late mortality occurred in 9 patients (7 patients recurrence of heart failure). Hemodynamics did not improve in one patient. The remaining 24 patients had initial hemodynamic improvement. The mean left ventricular ejection fraction improved from 44.76.3% to 55.71% and the mean aortic valve area improved from 0.67 cm2 to 0.98 cm2. 11 patients required re-hospitalization: two patients for a bridge to aortic valve replacement and the four patients for a repeat BAV procedure.
CONCLUSIONS: Early findings indicate that antegrade transspetal BAV is a feasible approach. This approarch remains important alternative method for patients of severehigh risk with severe pulmonary incerfisiency, anatomical problem for TAVR and unnecessary long term results by SAVR or TAVR.
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