Predictors of early restenosis after intracardiac echocardiography guided antegrade balloon aortic valvuloplasty in high
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ORIGINAL ARTICLE
Predictors of early restenosis after intracardiac echocardiography guided antegrade balloon aortic valvuloplasty in high-risk or inoperable patients Shinobu Hosokawa1 • Yoshikazu Hiasa1 • Akiho Seno1 • Tatuo Yasuoka1 Tomoko Izumi1 • Riyo Ogura1
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Received: 17 June 2016 / Accepted: 20 December 2016 Japanese Association of Cardiovascular Intervention and Therapeutics 2017
Abstract Antegrade balloon aortic valvuloplasty (BAV) may be more effective than retrograde BAV. However, early restenosis is found inconstantly within three months after BAV. To evaluate the factor of ER after intracardiac echocardiogram (ICE) guided Antegrade BAV, fifty patients with severe aortic stenosis (AS) underwent BAV procedures with ICE. ER was defined as mean aortic valve pressure gradient (PG) [40 mmHg. During one-year follow-up period, 6 patients died and 2 patients underwent aortic valve replacement. ER was present in 13 patients (26%) at three months after BAV. Procedural, clinical, and hemodynamic data were collected. The mean age of the patient population was 85.4 ± 7.6 years; the mean STS score and EuroSCORE were 7.8 ± 1.1 and 14.6 ± 4.1, respectively. The mean aortic valve PG decreased from 63.4 ± 19.8 to 28.5 ± 10.1 mmHg (p \ 0.0001). Baseline characteristics were similar between the two groups. There is no significant difference of mean aortic valve PG immediate after BAV(ER; 29 ± 8.8 mmHg, nonER; 21 ± 6.1 mmHg, p = ns). Univariate analysis showed patients with ER group had significantly higher rate of left ventricular hypertrophy, pulmonary hypertension, and high mean aortic valve PG at admission. Multivariate analysis revealed high mean aortic valve PG at admission as independent predictors of ER. Antegrade BAV may be effective for severe AS. Left ventricular hypertrophy, pulmonary hypertension and high mean PG were predictor
& Shinobu Hosokawa [email protected] 1
Division of Cardiology, Tokushima Red Cross Hospital, Irinokuchi103, Komatsushima-cho, Komatsushima 773-8502, Japan
of early restenosis. Early intervention should be considered for these patients. Keywords Aortic stenosis Antegrade balloon valvuloplasty Intracardiac echocardiography Early restenosis
Introduction Balloon aortic valvuloplasty has previously been used as a palliative procedure but has possibly been underused in patients with symptomatic aortic stenosis not suitable for surgical aortic valve replacement (AVR) [1]. Recently, BAV has been reconsidered as a bridge to surgical AVR or transcatheter aortic valve implantation (TAVI). Previous reports have shown that immediate adverse outcomes of BAV were not trivial, ranging from 15 to 43% for major procedural complications and from 1.6 to 10% for procedural and in-hospital mortality [2–10]. These reports described the results of the retrograde BAV procedure, and there remain few reports of antegrade transseptal BAV, mainly because this is considered to be a complex procedure. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have been us
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