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Balloon aortic valvuloplasty (BAV) is used as bridge to aortic valve replacement or for palliation of symptoms in patients not eligible for SAVR or TAVR. Regularly femoral acces is used, nevertheless complication rate is not negligible. The aim of our study was to establish the safety and the technical success of transradial BAV. Secondary objective was to determine the effectiveness and appropriate role and of transradial BAV.
14 patients with symptomatic severe aortic valve stenosis, who were unsuitable for SAVR or TAVR was not accessible were included in the study. All patients underwent both right and left radial and ulnar artery ultrasonography to define the safest access site. Transradial access was successfully obtained for 7-9 Fr sheath insertion in 12 patients from the right radial artery and 2 cases were performed from left radial artery. Contralateral radial access was used for the insertion of a pigtail catheter. A temporary pacemaker lead was implanted via the jugular vein. 16-18 mm diameter XXL Esophageal Balloon (Boston Scientific, Marlborough, MA, USA) (n=12) was delivered across a 7-8 Fr sheath. Thysak II ( NuMed, Inc., Hopkinton, NY, USA) (n=2) was advanced across 8 and 9 Fr sheaths. Valvuloplasty was performed during rapid pacing 160-180/min. During the procedure the efficacy of the procedure and the aortic valve insufficiency was measured both echocardiographycally and angiographycally.
Improved hemodynamic parameters were measured in all patients, mean AV gradient decreased from 48±31 to 38±25 mmHg, and AVA increased from 0.6±0.3 to 0.8±0.4 (33% increase). Prior to BAV all patients had NYHA III-IV heart failure symptoms, nevertheless discharge functional status markedly improved (NYHA I-III). In total, no major adverse cardiac or cerebrovascular event or vascular complication (according to VARC 2 criteria) occured during the interventions.
Radial artery access is a safe and effective option for balloon aortic valvuloplasty in patients with severe aortic valve stenosis. Using transradial access for BAV prevents the iliac artery from any possible modification of the vessel with closure device enableing later, safer femoral access for TAVR
STRUCTURAL: Valvular Disease: Aortic