Valvuloplastía Aórtica con balón como puente para reemplazo valvular aórtico percutáneo o quirúrgico en el manejo de la estenosis aórtica severa

background: the recent introduction of percutaneous aortic valve replacement (pavr) has become a stimulus to perform percutaneous aortic balloon valvu-loplasty (pabv) in patients with severe symptomatic aortic stenosis (as) as a bridge to valve replacement (avr) aim: to determine success rates and clinical results of pabv alone vs those obtained with pabv followed by either surgical or percutaneous avr. method: 472 patients with severe as underwent a total of 538 pabv procedures. 378 (82%) were treated with pabv alone (group i). in group ii, 85 patients (18%) had pabv followed by either pavr (n=65) or surgical avr (n=20). a successful pabv was defined as >40% reduction in mean aortic valve pressure gradient or >40% increase in aortic valve area results: groups i and ii were comparable regarding age (81.7±8.3 vs. 83.2±10.9 years, p=0.18), sts score (13.1±6.2 vs. 12.4±6.4, p=0.4) and logistic euroscore (45.4±22.3 vs. 46.9±21.8, p=0.43). mean increase in ava was 0.39±0.25 cm2 in group i and 0.42±0.26 cm2 in group ii (p=0.33). mean aortic valve pressure gradient decreased 24.1±13.1 mmhg in group i and 27 ±1.8 mmhg in group ii (p=0.06). pabv was not successful in 81 patients (15%). as expected, repeated pabv was the main predictor for failure (hr 4.34[95%, ci 2.2-8.3], p<0.001). midterm mortality rate was 55.2% (214 patients) in group i and 22.3% (19 patients) in group ii (p<0.001). intra-pro-cedure mortality was identical in both groups (2%). stroke occurred in 2.3% of patients in group i vs 1.6% in group ii. conclusion: in high risk patients with severe as and temporary contraindication for percutaneous or surgical avr, pabv may be used as a bridge for intervention with good midterm results.