Dataset Information

Impella CP-assisted balloon aortic valvuloplasty.

ABSTRACT: Percutaneous ventricular assist device (PVAD) use in balloon aortic valvuloplasty (BAV) has been performed sporadically. The PVAD used was TandemHeart. A few cases were reported using Impella 2.5 device. We report the first case of Impella CP-assisted BAV. The use of PVAD has been contraindicated in severe aortic stenosis (AS). However, the various benefits of PVAD, including circulatory support and minimizing interruption of blood flow during balloon inflation, made its use attractive in high-risk BAV. We recommend that severe AS no more stays as a contraindication to the use of PVADs. .

SUBMITTER: Megaly M

PROVIDER: S-EPMC6282924 | biostudies-literature | 2016 Aug

REPOSITORIES: biostudies-literature

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Impella CP-assisted balloon aortic valvuloplasty.

Megaly Michael M Jones Paul P

Journal of cardiology cases 20160412 2

Percutaneous ventricular assist device (PVAD) use in balloon aortic valvuloplasty (BAV) has been performed sporadically. The PVAD used was TandemHeart. A few cases were reported using Impella 2.5 device. We report the first case of Impella CP-assisted BAV. The use of PVAD has been contraindicated in severe aortic stenosis (AS). However, the various benefits of PVAD, including circulatory support and minimizing interruption of blood flow during balloon inflation, made its use attractive in high-r ...[more]

PMID: 30546662

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Project description:BackgroundAortic valve stenosis is the most common type of congenital left ventricular (LV) outflow tract obstruction. Balloon aortic valvuloplasty (BAV) has become the first-line treatment pathway in many centers. Our aim was to assess the trajectory of LV remodeling following BAV in children and its relationship to residual aortic stenosis (AS) and insufficiency (AI).MethodsChildren <18 years of age who underwent BAV for isolated aortic stenosis from 2004 to 2012 were eligible for inclusion. Those with AI before BAV, other complex congenital heart lesions, or <2 accessible follow-up echocardiograms were excluded. Baseline and serial echocardiographic data pertaining to aortic valve and LV size and function were retrospectively collected through December 2017 or the first reintervention. Longitudinal data was assessed using per-patient time profiles with superimposed trend lines using locally estimated scatterplot smoothing. Associations with reintervention or death were also evaluated.ResultsAmong the 98 enrolled children, the median (interquartile range) age at BAV was 2.8 months (0.2-75). The median (interquartile range) follow-up was 6.8 years (1.9-9.0). Children with predominantly residual AI (n=11) demonstrated progressive increases in their LV end-diastolic dimension Z score within the first 3 years after the BAV, followed by a plateau (P<0.001). Their mean LV circumferential and longitudinal strain values remained within the normal range but lower than in the non-AI group (P<0.001 and P=0.001, respectively). Children with predominantly residual aortic stenosis (n=44) had no changes in LV dimensions but had a rapid early increase in mean LV circumferential and longitudinal strain. The cumulative proportion (95% CI) of reintervention at 5 years following BAV was 33.7% (23.6%-42.4%).ConclusionsOur study demonstrates that LV remodeling occurs mainly during the first 3 years in children with predominantly residual AI after BAV, with no subsequent significant functional changes over the medium term. These data improve our understanding of expected patient trajectories and thus may inform decisions on the timing of reintervention.

Dataset Information

Impella CP-assisted balloon aortic valvuloplasty.

Publications

Impella CP-assisted balloon aortic valvuloplasty.

Similar Datasets

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