1. Feasibility and technicality of aortic valve lithotripsy-facilitate balloon valvuloplasty in patients with severe aortic stenosis unsuitable for immediate valvular replacement.
- Author
-
Fang JX, O'Neill BP, Wang DD, Giustino G, von Buchwald CL, Lee JC, Engel Gonzalez P, Frisoli TM, O'Neill WW, and Villablanca PA
- Subjects
- Humans, Male, Female, Treatment Outcome, Aged, 80 and over, Aged, Time Factors, Hemodynamics, Recovery of Function, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis surgery, Aortic Valve Stenosis therapy, Aortic Valve Stenosis mortality, Balloon Valvuloplasty adverse effects, Feasibility Studies, Lithotripsy adverse effects, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve surgery, Severity of Illness Index
- Abstract
Background: Aortic valve lithotripsy can fragment aortic valve calcium deposits and potentially restore leaflet pliability in animal model and ex-vivo, but clinical data is limited. Transcatheter aortic valve implantation (TAVR) might not be feasible as an urgent procedure in critically ill patients. Balloon valvuloplasty has the major limitation of valve recoil and inducing aortic regurgitation., Aims: To determine the clinical feasibility of aortic valve lithotripsy-facilitated balloon valvuloplasty in patients with severe aortic stenosis unsuitable for valvular replacement., Methods: We performed lithotripsy as adjunctive therapy to balloon aortic valvuloplasty in ten consecutive patients, most of whom were deemed unfit for TAVR. Lithotripsy of the aortic valve was performed with simultaneous inflation of one to three peripheral lithotripsy balloons to deliver ultrasound pulses. Rapid pacing was not used during lithotripsy. Aortic valve velocity, gradient, and valve area were measured before and after the procedure by echocardiogram. Transvalvular pressure gradient was recorded intra-procedurally. Periprocedural and ninety-day clinical outcomes were followed., Results: Procedure was technically successful in 9 out of 10 patients and aborted in one patient due to cardiogenic shock. One patient had femoral closure device related complication. There was a statistically significant decrease in valvular gradient and increase in aortic valve area. 9 out of 10 patients recovered from acute episode and were discharged. 6 patients had improvement in NYHA class. 4 patients were subsequently able to receive TAVR. 90-day mortality occurred in 3 patients. There was no stroke or bradyarrhythmia peri-procedurally and no heart failure hospitalization at 90 days., Conclusion: Aortic valve lithotripsy-facilitated balloon valvuloplasty has reasonable feasibility, safety and technical reproducibility and acute clinical result. Hemodynamic effect is similar to that of balloon valvuloplasty reported in the literature. Subsequent Prognosis is not altered in critically ill patients., Competing Interests: Declaration of competing interest Dr. B. P. O'Neill is a consultant to and receives research support from Edwards Lifesciences. Dr. T. Frisoli is a proctor for Edwards Lifesciences, Abbott, Boston Scientific, and Medtronic. Dr. D. D. Wang is a consultant for Edwards Lifesciences, Abbott, Neochord, and Boston Scientific and receives research grant support from Boston Scientific assigned to employer Henry Ford Health System. Dr. W. O'Neill has served as a consultant for Abiomed, Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Vascular, and St. Jude Medical and serves on the Board of Directors of Neovasc Inc. Dr. P. A. Villablanca is a consultant for Edwards Lifesciences and Teleflex. The other authors had no conflicts to declare. The other authors have no potential conflict of interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF