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Minerva Cardiology and Angiology 2021 Mar 11

DOI: 10.23736/S2724-5683.21.05611-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Balloon aortic valvuloplasty through the novel transradial technique

Horacio MEDINA DE CHAZAL 1 , Ignacio SEROPIAN 1, Francisco ROMEO 2, Juan G. CHIABRANDO 1, Juan VALLE RALEIGH 1, Daniel H. BERROCAL 1, Carla AGATIELLO 1

1 Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 2 Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai St. Luke’s and West, New York, NY, USA


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BACKGROUND: Balloon aortic valvuloplasty (BAV) has been typically performed through a femoral approach thus increasing the risk of bleeding and access site-related vascular complications. The aim of this study was to describe the safety and efficacy of transradial aortic valve valvuloplasty (TRBAV).
METHODS: Retrospective, single-center study including patients undergoing TRBAV (October 2019-July 2020). BAV was performed using 18-25 mm balloons through an 8-10 french (F) radial sheath. Successful BAV was defined as ≥50% reduction in peak-to-peak gradient (efficacy endpoint). Procedural complications, including radial artery occlusion (RAO) at follow-up were evaluated (safety endpoint).
RESULTS: Twenty-four patients underwent TRBAV were included, aged 81 (73-85) years, 70% males, EuroScoreII 3.1 (2.1-5.5). Aortic valve gradient was significantly reduced (pre 50±24 vs 18.7±13 mmHg post, p<0.001), and 91% had successful BAV. Mean gradient drop was 31.4±16.8 mmHg. One patient (4%) required cross-over to femoral access for severe vasospasm, and was excluded from the analysis. Most used sheaths were 8F (46%) and 9F (37%), mostly for 20mm (50%) and 23mm (38%) balloons. There were neither major procedural complications (neither balloon entrapment nor compartmental syndrome) nor minor complications (any accesssite bleeding). RAO was observed in 2 patients (8%), both asymptomatic.
CONCLUSIONS: TRBAV was safe, feasible, and efficacious with a small rate of conversion and RAO, suggesting reproducibility of this novel technique. TRBAV may represent an alternative to femoral access in selected patients although larger studies are warranted.


KEY WORDS: Aortic stenosis; Transradial balloon aortic valvuloplasty

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