Good Outcomes With Ultrasound-Guided PBAV for Symptomatic Aortic Stenosis

Ultrasound-guided percutaneous balloon aortic valvuloplasty (PBAV) was found to be effective and to be associated with good clinical and echocardiographic short-term outcomes in patients with symptomatic aortic stenosis, according to study results published in the Journal of Interventional Cardiology.

Investigators sought to explore the feasibility and efficacy of using ultrasound guidance instead of X-ray or computed tomography for PBAV.

In this study, 30 patients (mean age, 61.5±4.5 years; 53.3% women) who underwent ultrasound-guided PBAV for symptomatic moderate/severe aortic stenosis between January 2016 and July 2019 at a Chinese hospital, were enrolled. Participants were ineligible for or refused treatment with surgical valve replacement. The New York Heart Association (NYHA) grading system (I-IV) was used to assess cardiac function prior to PBAV and 1 month post-procedure. Doppler echocardiography was used to assess aortic valve orifice area (AVA), aortic peak jet velocity, left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), and mean transvalvular pressure gradient before and immediately after PBAV.

At baseline, there were 3, 9, 10, and 8 patients for whom cardiac function was rated as NYHA grades I, II, III, and IV, respectively. At 1 month after PBAV, there were 22, 4 and 4 cases with cardiac function rated as grades I, II and III, respectively, and no cases with grade 4, indicating significant improvement in cardiac function after ultrasound-guided PBAV (P <.001).

All major echocardiographic parameters were found to be improved post vs pre-procedure, including AVA (1.96±0.25 cm² vs 0.98±0.12 cm², respectively; P =.031), aortic peak jet velocity (3.68±0.811 m/s vs 4.79±0.63 m/s, respectively; P <.001), LVESD (35.50±2.62 mm vs 45.20±2.42 mm, respectively; P =.047), LVEDD (51.90±3.21 mm vs 65.60±6.81 mm, respectively; P =.038), LVEF (63.46%±11.29% vs 56.31%±11.04%, respectively; P =.011), and mean transvalvular pressure gradient (33.77±13.85 mm Hg vs 54.54±13.81 mm Hg, respectively; P <.001). There were no complications related to the procedure.

Study limitations include the small sample size, single-center setup, case series design, short follow-up period, lack of a comparator group, lack of a formal safety analysis, and potential non-generalizability to wider populations.

“If the effectiveness and safety of our innovative approach are validated in additional larger-scale studies, the routine application of ultrasound during interventional techniques potentially could be expanded to include PBAV in patients with aortic stenosis,” noted the authors.

Reference

Li Y, Pang K, Liu Y, Li M, Wang H. Ultrasound-guided percutaneous balloon aortic valvuloplasty for aortic stenosis. J Interv Cardiol. 2020;2020:1-6. doi:10.1155/2020/8086796