Balloon aortic valvuloplasty in the transcatheter aortic valve replacement era

BACKGROUND: The introduction of transcatheter aortic valve replacement (TAVR) has renewed interest in balloon aortic valvuloplasty (BAV) for severe aortic stenosis (AS). It is unclear whether technical advances and increased operator experience associated with TAVR development have resulted in improved BAV outcomes. We performed a systematic review encompassing all published BAV studies and examined the evolution in indications, outcomes, and complications of BAV procedures since its inception. METHODS: A literature search from 1986 through June 2013 was conducted for all studies reporting BAV outcomes. Studies with <50 BAV procedures were excluded. BAV outcomes and complications were compared in studies enrolling patients in the early/pre-TAVR and contemporary/TAVR periods (before vs after 2005). RESULTS: Twenty-seven studies representing 4123 patients were included. In the contemporary era, BAV was performed as a bridge to TAVR in 23.4% of patients. Significant and comparable improvement in transaortic valvular gradients, aortic valve area, and cardiac output following BAV were observed in both time periods. There was, however, a significant reduction in procedural death (1.5% vs 2.9%; P<.01), in-hospital mortality (4.6% vs 8.5%; P<.001), and major vascular complications (4.0% vs 10.2%; P<.001) associated with BAV procedures in the contemporary/TAVR era. CONCLUSION: BAV is increasingly used as a bridge to TAVR, continues to impart significant hemodynamic improvement in patients with severe AS, and has an improved safety profile in the contemporary era.