TY - JOUR JO - EuroIntervention TI - Balloon Aortic Valvuloplasty for Severe Aortic Stenosis Before Urgent Noncardiac Surgery AB - <div><span lang="EN-AU"><strong>Background:</strong> Balloon aortic valvuloplasty (BAV) has been proposed as a therapeutic option in patients suffering from&nbsp;</span><span lang="EN-AU">severe aortic stenosis (SAS)&nbsp;</span><span lang="EN-AU">who need urgent&nbsp;</span><span lang="EN-AU">noncardiac surgery (NCS).</span><span lang="EN-AU">&nbsp;Whether this strategy is better than medical therapy in this very peculiar population is unknown.&nbsp;</span></div> <div><span lang="EN-AU"><strong>Aims:</strong>&nbsp;We evaluated the clinical benefit of an invasive strategy (IS) with preoperative BAV in patients with SAS requiring urgent NCS.</span></div> <div><span lang="EN-AU"><strong>Methods:</strong>&nbsp;</span><span lang="EN-AU">From 2011 to 2019, a registry conducted in 2 centers included 133 patients with SAS undergoing urgent NCS, of whom n=93 underwent preoperative BAV (IS) and n=40 a conservative strategy (CS) without BAV.&nbsp;</span><span lang="EN-AU">All analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW)</span><span lang="EN-AU">&nbsp;(10 clinical and anatomical variables). The primary outcome was the MACE at 1-month follow-up after NCS including mortality, heart-failure, and other cardiovascular outcomes.</span></div> <div><span lang="EN-AU"><strong>Results:</strong>&nbsp;</span>In patients managed conservatively, occurrence of MACE was 20.0%(n=8) and death was 10.0%(n=4) at 1 month. In patients undergoing BAV, occurrence of MACE was 20.4%(n=19) and death was 5.4%(n=5) at 1-month. Among patients undergoing conservative management, all events were observed after NCS while in patients undergoing BAV, 12.9%(n=12) had events between BAV and NCS including 3 deaths and 7.5% (n=7) after NCS including 2 deaths.</div> <div><span lang="EN-AU">In IPTW-propensity analyses, the incidence of the primary outcome (20.4% vs. 20.0%;OR=0.93;95%CI:0.38-2.29) and 3-months survival (89.2% vs. 90.0%;IPTW-adjustedHR=0.90;95%CI:0.31-2.60) were similar in both groups.<br /></span><span lang="EN-AU"><strong>Conclusions:</strong>&nbsp;</span><span lang="EN-AU">Patients with SAS managed conservatively before urgent NCS are at high risk of events. A systematic&nbsp;</span><span lang="EN-AU">invasive strategy using BAV does not provide a significant improvement in clinical outcome.</span></div> <p>&nbsp;</p> <p><strong>&nbsp;</strong></p> AU - Debry Nicolas AU - Altes Alexandre AU - Vincent Flavien AU - Delhaye Cédric AU - Schurtz Guillaume AU - Nedjari Farid AU - Legros Gabin AU - Porouchani Sina AU - Coisne Augustin AU - Richardson Marjorie AU - Cosenza Alessandro AU - Verdier Basile AU - Denimal Tom AU - Pamart Thibault AU - Spillemaeker Hugues AU - Sylla Habib AU - Sudre Arnaud AU - Janah Dany AU - Aouate David AU - Marsou Wassima AU - Appert Ludovic AU - Lemesle Gilles AU - Labreuche Julien AU - Van Belle Eric AU - Maréchaux Sylvestre VL - IS - Y1 - 08/06/2021 Y1 - 2021 DOI - 10.4244/EIJ-D-20-01423 SP - KW - miscellaneous KW - aortic stenosis KW - balloon valvuloplasty PB - Europa Digital & Publishing UR - https://eurointervention.pcronline.com/article/balloon-aortic-valvuloplasty-for-severe-aortic-stenosis-before-urgentnoncardiac-surgery SN - 1774-024X ER -