The Therapeutic Efficacy of Antegrade Balloon Aortic Valvuloplasty under Intra-aortic Balloon Pumping for Treating Cardiogenic Shock due to Critical Aortic Valve Stenosis

Background: Treatment of critical Aortic Stenosis (AS) in hemodynamically unstable patients is a major clinical challenge.

Objectives: This study aimed to retrospectively investigate the safety of antegrade Balloon Aortic Valvuloplasty (BAV) using the Inoue balloon and an Intra-Aortic Balloon Pump (IABP) for treating AS with cardiogenic shock and to determine the immediate efficacy of the procedure with respect to hemodynamic improvements in patients with critical symptomatic AS.

Patients and Methods: This retrospective study was conducted on 47 symptomatic critical AS patients excluded from undergoing surgical aortic valve replacement who were treated using antegrade BAV. The high-risk group included 14 cases whose mean Left Atrial Pressure (LAP) remained above 25 mmHg despite aggressive medical therapy. These cases were treated using antegrade BAV and an IABP (BAV-IABP group). On the other hand, 33 cases with stable hemodynamics due to medications comprised the relatively low-risk group and were treated using antegrade BAV alone (BAV-alone group).

Results: Immediate procedural success was achieved in all cases within 24 h. In the BAV-IABP group, the proportion of patients with improved aortic valve areas (125.6 ± 56.7% vs. 70.9 ± 32.3%, P < 0.004), reduced pressure gradients (67.8 ± 9.1% vs. 59.6 ± 17.2%, P < 0.040), and decreased LAP (48.4 ± 15.4% vs. 17.9±9.9%, P < 0.001) was significantly larger compared to the BAV-alone group.

Conclusions: Antegrade BAV under IABP provided safe and effective immediate valvuloplasty in very high-risk patients who were not suitable for definitive therapy.