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Valvuloplasty improves short-term outcomes for inoperable patients with aortic stenosis
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Balloon aortic valvuloplasty was associated with greater survival at 3 months and quality of life at 6 months compared with no valvuloplasty among inoperable patients with severe symptomatic aortic stenosis not undergoing transcatheter aortic valve replacement in the PARTNER trial. However, the benefits were not sustained during longer follow-up.
PARTNER cohort B included 179 inoperable patients randomly assigned to standard treatment. The current analysis focused on 39 of those patients who underwent balloon aortic valvuloplasty (BAV) before enrollment and 102 who underwent BAV within 30 days of randomization (median, 3 days).
Many PARTNER centers used BAV as the next treatment tool for patients with severe symptomatic AS already receiving optimal medical therapy. Seventeen of 22 participating centers used BAV in more than half of patients randomly assigned to standard therapy, and 10 used it in more than 90% of patients.
In total, 189 BAVs were performed during the trial. Eight deaths (4.2%) and two strokes (1.1%) occurred within 30 days after BAV.
At 3 months, survival was higher among patients who underwent BAV after randomization compared with previous BAV (88.2% vs. 73%). At 6 months, survival was similar between the two groups (74.5% vs. 73.1%, respectively).
When the researchers compared QOL parameters at baseline, 30 days and 6 months, results favored the group that underwent BAV after randomization, but effect did not persist at 12 months. In particular, the researchers reported “meaningful improvement” in HF symptoms among patients who underwent BAV after randomization.
Predictors of mortality in this population included previous stroke or transient ischemic attack, previous pacemaker implantation and higher STS score.
Compared with baseline, BAV improved mean gradient by 13.2 mm Hg (P < .001) and aortic valve area by 0.2 cm2 (P < .001), but “hemodynamic improvement after the second BAV was negligible,” according to the researchers.
“Standard therapy for [aortic stenosis] in patients who cannot undergo surgery is inadequate. BAV for some patients who cannot undergo aortic valve replacement is a useful palliative therapy,” they concluded. – by Rob Volansky
Disclosure: The PARTNER trial was funded by Edwards Lifesciences. Kapadia reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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