Review Article   

Minerva Cardiology and Angiology 2022 Mar 25

DOI: 10.23736/S2724-5683.22.05997-X

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Balloon aortic valvuloplasty review: the revenge during COVID-19 outbreak?

Bernardo CORTESE ^{1, 2} ✉, Erick SANCHEZ-JIMENEZ ¹, Alfonso IELASI ³, Flavio BICCIRÈ ⁴, Simone BUDASSI ⁴, Francesco PRATI ⁴, Guido GELPI ^{2, 5}

¹ Interventional cardiology department, Clinica Polispecialistica San Carlo, Milano, Italy; ² Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy; ³ Interventional cardiology department, Istituto Clinico Sant'Ambrogio, Milano, Italy; ⁴ Interventional cardiology department, Ospedale San Giovanni Addolorata, Roma, Italy; ⁵ Interventional cardiology department, ASST-Fatebenefratelli-Sacco, Milano, Italy

Aortic stenosis is a highly prevalent cardiac valvular disease in adult population and increases with age. After symptoms onset in severe aortic stenosis, the prognosis begins to decline; however, new studies demonstrate an increased risk of death in patients with moderate disease. Although majority of patients with severe aortic stenosis are treated electively with surgical or transcatheter aortic valve replacement, not all patients are candidates for the interventions. Balloon aortic valvuloplasty can be used successfully as a bridge to definitive treatment or as palliative therapy in patients who are not candidates for either procedure. In this paper, we discuss and justify the current indications and contraindications for balloon aortic valvuloplasty. Additionally, the step-by-step procedure technique and most frequent complications are described. Moreover, we present the safety and feasibility of balloon aortic valvuloplasty in 33 consecutive patients on a waiting list for transcatheter aortic valve replacement at 3 expert Italian centers during the first and second waves of COVID-19, when clinical priorities focused on hospitalized patients with pneumonia. The procedural success in this cohort of patients was achieved in 31 patients (94%). Out of the 33 patients enrolled, 15 underwent TAVR within 5 ± 2 months from the valvuloplasty, and at 6-month follow-up a total of 2 patients died for end-stage heart failure.

KEY WORDS: TAVR; SAVR; Covid-19 pandemic; Aortic stenosis; Balloon aortic valvuloplasty