PURPOSE: Percutaneous Aortic Balloon Valvuloplasty (PABV) is an alternative when surgery is not an option for severe aortic stenosis. Rapid ventricular pacing has been used to stabilize balloon position and this might be challenging in elderly patients with severe coronary artery disease (CAD) or history of cerebrovascular accident (CVA). Duration of balloon inflation is also an issue with PABV. The percutaneous trans-septal ventricular assistance (PTVA) TandemHeart® CardiacAssist device is a left ventricular assist device which can be used to provide short-term hemodynamic support.
METHODS: Data on six patients in heart failure undergoing PABV with the use of PTVA at Lenox Hill Hospital between 9/06 until 11/07 were reviewed retrospectively. Clinical, angiographic and hemodynamic data were recorded. The combination of Left main/left main equivalent disease with compromised left ventricular function makes PTVA an ideal device for valvuloplasty in such patients.
RESULTS: The mean age of patients was 82 ± 10 yrs with mean PCWP of 27 mmHg prior to procedure. Patient characteristics are shown in table1. PTVA was successfully placed, and removed after the completion of the PABV. The retrograde approach was used in all the patients. The mean aortic valve area increased from 0.55 ± 0.1 cm2 at baseline to 0.9 ± 0.2 cm2 (P=0.006) post procedure. The maximum duration of total balloon inflation time 85 sec with no compromise in cardiac output. No cardiovascular complications were reported during or post procedure. All patients were discharged in stable condition from the hospital with the average length of stay of 3±1 days and a significant improvement in clinical status.
CONCLUSION: There is no ejection across the aortic valve providing an opportunity to optimize balloon inflations for valvuloplasty also the use of the PTVA for PABV maintains adequate cardiac output and provides optimum hemodynamic support enabling prolonged balloon inflations.
CLINICAL IMPLICATIONS: PTVA provides an alternative strategy to rapid ventricular pacing in high risk patients for PABV.
DISCLOSURE: Manish Gupta, No Financial Disclosure Information; Product/procedure/technique that is considered research and is NOT yet approved for any purpose. Use of the Device for Valvuloplasty.