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OBJECTIVE: Transcatheter aortic valve implantation is an alternative procedure for these patients, but is expensive and the mortality and morbidity rates are high. Certain papers have reported that an Inoue balloon catheter is more effective when inserted via an antegrade transseptal approach compared with a retrograde approach as access complications are rare and the postintervention aortic valve area large. At our institution, high-risk patients underwent antegrade transseptal aortic balloon aortic valvuloplasty (BAV) with an Inoue balloon catheter.
METHODS: From July 2011, 11 consecutive patients underwent antegrade transseptal BAV using an Inoue balloon. All patients were considered to have an unacceptably high risk for surgical aortic valve replacement. The study group was characterized by their advanced age (mean 82.5 years). The mean follow-up was 12 months. Three 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 intracardiac echo. 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. Systemic pressure was monitored and the Inoue balloon was inflated 10-20 times across the aortic valve depending on the aortic annural size.
RESULTS: There were two in-hospital deaths (one after aortic valve replacement surgery and one due to heart failure). Late mortality occurred in one patient (recurrence of heart failure). Hemodynamics did not improve in one patient after this procedure and the patient died after intervention day 1. The remaining 10 patients had initial hemodynamic improvement. The mean left ventricular ejection fraction improved from 46.3% to 55.7% and the mean aortic valve area improved from 0.66 cm2 to 0.90 cm2. No patient experienced a cerebral infarction and access was easy for all patients.
CONCLUSIONS: Early findings indicate that antegrade transspetal BAV is a feasible approach. Antegrade BAV remains important alternative method for patients of high risk and unnecessary long term results by AVR or TAVI.