INVASIVE INTERVENTIONS IN STRUCTURAL HEART DISEASES: COMPREHENSIVE TECHNIQUES

Invasive Interventions in Structural Heart Diseases-kapak

PERCUTANEOUS BALLOON AORTIC VALVULOPLASTY

Can Özkan

Bursa City Hospital, Department of Cardiology, Bursa, Türkiye

Özkan C. Percutaneous Balloon Aortic Valvuloplasty. In: Tanık VO, Özlek B, editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.205-213.

ABSTRACT

Critical aortic stenosis (AS) is a common and life-threatening condition, particularly among individuals aged 75 and older. In symptomatic and severe cases of AS, surgical aortic valve replacement (SAVR) has traditionally been the treatment of choice. However, alternative treatment options are needed for patients who are at high surgical risk or unsuitable candidates for surgery. In this context, percutaneous approaches, such as transcatheter aortic valve implantation (TAVI) and balloon aortic valvuloplasty (BAV), play a significant role in the management of these patients. Introduced by Cribier in 1986, BAV was initially developed as an alternative for elderly patients with severe AS who were unsuitable for surgery. Balloon aortic valvuloplasty has been used to achieve temporary symptomatic relief in patients where opening of the valve leaflets is hindered by excessive calcification. However, BAV’s long-term effects are limited, with restenosis and clinical deterioration typically occurring within 6-12 months. As a result, BAV is not a permanent solution but can be used as a bridge, particularly in high-risk patients requiring urgent non-cardiac surgery, or as an alternative to SAVR or TAVI.

This chapter provides a detailed review of the indications, mechanisms, patient populations, complications, and limitations of the BAV procedure. The chapter focuses on the importance of appropriate patient selection, the need for a multidisciplinary approach before treatment, the management of complication risks, and the long-term follow-up process. Additionally, a thorough examination of the current literature, experimental findings, and clinical data regarding the safety and efficacy of BAV is presented. It is highlighted that, although BAV provides only limited long-term survival when compared to SAVR and TAVI, it offers temporary symptomatic improvement in specific patient groups. In conclusion, the clinical outcomes and long-term effectiveness of BAV require careful consideration during treatment planning. This chapter offers valuable insights for clinical practitioners seeking to understand and apply various approaches in the management of cardiovascular diseases.

Keywords: Aortic valve stenosis; Transcatheter aortic valve replacement; Balloon valvuloplasty

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