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Article Dans Une Revue EuroIntervention Année : 2021

Balloon aortic valvuloplasty for severe aortic stenosis before urgent non-cardiac surgery

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Alexandre Altes
  • Fonction : Auteur
Farid Nedjari
  • Fonction : Auteur
Gabin Legros
  • Fonction : Auteur
Augustin Coisne
  • Fonction : Auteur
Tom Denimal
  • Fonction : Auteur
Thibault Pamart
Hugues Spillemaeker
  • Fonction : Auteur
Habib Sylla
  • Fonction : Auteur
Dany Janah
  • Fonction : Auteur
David Aouate
  • Fonction : Auteur
Ludovic Appert
  • Fonction : Auteur

Résumé

Background: Balloon aortic valvuloplasty (BAV) has been proposed as a therapeutic option in patients suffering from severe aortic stenosis (SAS) who need urgent non-cardiac surgery (NCS). Whether this strategy is better than medical therapy in this very specific population is unknown. Aims: We aimed to evaluate the clinical benefit of an invasive strategy (IS) with preoperative BAV in patients with SAS requiring urgent NCS. Methods: From 2011 to 2019, a registry conducted in two centres included 133 patients with SAS undergoing urgent NCS, of whom 93 underwent preoperative BAV (IS) and 40 a conservative strategy (CS) without BAV. All analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW) (10 clinical and anatomical variables). Results: The primary outcome was MACE at one-month follow-up after NCS including mortality, heart failure, and other cardiovascular outcomes. In patients managed conservatively, occurrence of MACE was 20.0% (n=8) and death was 10.0% (n=4) at 1 month. In patients undergoing BAV, the occurrence of MACE was 20.4% (n=19) and death was 5.4% (n=5) at 1 month. Among patients undergoing conservative management, all events were observed after NCS while, in patients undergoing BAV, 12.9% (n=12) had events between BAV and NCS including 3 deaths, and 7.5% (n=7) had events after NCS including 2 deaths. In IPTW propensity analyses, the incidence of the primary outcome (20.4% vs 20.0%; OR 0.93, 95% CI: 0.38-2.29) and three-month survival (89.2% vs 90.0%; IPTW-adjusted HR 0.90, 95% CI: 0.31-2.60) were similar in both groups. Conclusions: Patients with SAS managed conservatively before urgent NCS are at high risk of events. A systematic invasive strategy using BAV does not provide a significant improvement in clinical outcome.
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Dates et versions

hal-03583309 , version 1 (21-02-2022)

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Citer

Nicolas Debry, Alexandre Altes, Flavien Vincent, Cedric Delhaye, Guillaume Schurtz, et al.. Balloon aortic valvuloplasty for severe aortic stenosis before urgent non-cardiac surgery. EuroIntervention , 2021, 17 (8), pp.E680+. ⟨10.4244/EIJ-D-20-01423⟩. ⟨hal-03583309⟩
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