Balloon aortic valvuloplasty

Abstract

Balloon aortic valvuloplasty (BAV) refers to transcatheter balloon dilatation of valvular aortic stenosis (AS) in order to alleviate the mechanical impediment to left ventricular outflow and provide relief from heart failure symptomatology. The procedure has been applied successfully in congenital aortic valve stenosis (Fratz et al. 2008) and has been studied extensively in calcific degenerative aortic stenosis in adults (Safian et al. 1988a; McKay et al. 1987; Cribier et al. 1986; Berland et al. 1989; Bernard et al. 1990; American Heart Association 1991; Kuntz et al. 1992) were its role is mostly palliative or as a bridge to more definitive surgical or interventional therapy. After initial enthusiasm following the introduction of the technique in 1985 when it was heralded as a possible viable alternative to surgical aortic valve replacement, BAV fell by the wayside due to recognition of transient improvement in aortic stenosis hemodynamics, associated morbidity and even mortality of the procedure, and failure to alter the natural history of symptomatic aortic stenosis (Lieberman et al. 1995). However after a long period of decline, BAV has had exponential growth in recent years in parallel with the advent of transcatheter aortic valve replacement (Dean 2009; Hara et al. 2007). Refinements in BAV technique have led to improved safety and reduced morbidity and novel applications (e.g. drug coated balloons (Spargias et al. 2009a)) are being developed.