Patients with small left ventricular size undergoing balloon aortic valvuloplasty have worse intraprocedural outcomes

Creighton Don, Pritha P. Gupta, Christian Witzke, Manoj Kesarwani, Roberto J. Cubeddu, Ignacio Inglessis, Igor F. Palacios

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives To evaluate the impact of left ventricular (LV) chamber size on procedural and hospital outcomes of patients undergoing aortic valvuloplasty. Background Balloon aortic valvuloplasty (BAV) is used as an integral step during transcatheter aortic valve implantation. Patients with small, thickened ventricles are thought to have more complications during and following BAV. Methods Retrospective study of consecutive patients with severe, symptomatic calcific aortic stenosis who underwent retrograde BAV at Massachusetts General Hospital. We compared patients with left ventricular end-diastolic diameters (LVEDD) <4.0 cm (n = 31) to those with LVEDD ≥4.0 cm (n = 78). Baseline and procedural characteristics as well as clinical outcomes were compared. Multivariate logistic regression was used for the adjusted analysis. Results Patients with smaller LV chamber size were mostly women (80.7% vs. 19.4%, P < 0.01) and had a smaller body surface area (BSA), (1.61 ± 0.20 m 2 vs. 1.79 ± 0.25 m2, P < 0.01). Patients with smaller LV chamber size had higher ejection fractions and thicker ventricles. Otherwise, baseline characteristics were similar. The intraprocedural composite of death, cardiopulmonary arrest, intubation, hemodynamic collapse, and tamponade was higher for patients with LVEDD < 4.0 cm (32.3% v. 11.5%, P = 0.01). Adjusting for age, gender, BSA, LV pressure, and New York Heart Association class, LVEDD < 4.0 cm remained an independent predictor of procedural (OR 5.1, 95% CI 1.4-18.2) and in-hospital complications (OR 3.8, 95% CI 1.2-11.6). Conclusions Compared to patients undergoing BAV with LVEDD ≥4.0 cm, those with smaller LV chambers had worse procedural and in-hospital outcomes.

Original languageEnglish (US)
Pages (from-to)946-954
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume80
Issue number6
DOIs
StatePublished - Nov 15 2012
Externally publishedYes

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Balloon Valvuloplasty
Body Surface Area
Ventricular Pressure
Heart Arrest
Intubation
General Hospitals
Retrospective Studies
Logistic Models
Hemodynamics

Keywords

  • aortic valve stenosis
  • hypertrophic obstructive cardiomyopathy
  • left ventricular hypertrophy
  • subaortic stenosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Patients with small left ventricular size undergoing balloon aortic valvuloplasty have worse intraprocedural outcomes. / Don, Creighton; Gupta, Pritha P.; Witzke, Christian; Kesarwani, Manoj; Cubeddu, Roberto J.; Inglessis, Ignacio; Palacios, Igor F.

In: Catheterization and Cardiovascular Interventions, Vol. 80, No. 6, 15.11.2012, p. 946-954.

Research output: Contribution to journalArticle

Don, Creighton ; Gupta, Pritha P. ; Witzke, Christian ; Kesarwani, Manoj ; Cubeddu, Roberto J. ; Inglessis, Ignacio ; Palacios, Igor F. / Patients with small left ventricular size undergoing balloon aortic valvuloplasty have worse intraprocedural outcomes. In: Catheterization and Cardiovascular Interventions. 2012 ; Vol. 80, No. 6. pp. 946-954.
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abstract = "Objectives To evaluate the impact of left ventricular (LV) chamber size on procedural and hospital outcomes of patients undergoing aortic valvuloplasty. Background Balloon aortic valvuloplasty (BAV) is used as an integral step during transcatheter aortic valve implantation. Patients with small, thickened ventricles are thought to have more complications during and following BAV. Methods Retrospective study of consecutive patients with severe, symptomatic calcific aortic stenosis who underwent retrograde BAV at Massachusetts General Hospital. We compared patients with left ventricular end-diastolic diameters (LVEDD) <4.0 cm (n = 31) to those with LVEDD ≥4.0 cm (n = 78). Baseline and procedural characteristics as well as clinical outcomes were compared. Multivariate logistic regression was used for the adjusted analysis. Results Patients with smaller LV chamber size were mostly women (80.7{\%} vs. 19.4{\%}, P < 0.01) and had a smaller body surface area (BSA), (1.61 ± 0.20 m 2 vs. 1.79 ± 0.25 m2, P < 0.01). Patients with smaller LV chamber size had higher ejection fractions and thicker ventricles. Otherwise, baseline characteristics were similar. The intraprocedural composite of death, cardiopulmonary arrest, intubation, hemodynamic collapse, and tamponade was higher for patients with LVEDD < 4.0 cm (32.3{\%} v. 11.5{\%}, P = 0.01). Adjusting for age, gender, BSA, LV pressure, and New York Heart Association class, LVEDD < 4.0 cm remained an independent predictor of procedural (OR 5.1, 95{\%} CI 1.4-18.2) and in-hospital complications (OR 3.8, 95{\%} CI 1.2-11.6). Conclusions Compared to patients undergoing BAV with LVEDD ≥4.0 cm, those with smaller LV chambers had worse procedural and in-hospital outcomes.",
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T1 - Patients with small left ventricular size undergoing balloon aortic valvuloplasty have worse intraprocedural outcomes

AU - Don, Creighton

AU - Gupta, Pritha P.

AU - Witzke, Christian

AU - Kesarwani, Manoj

AU - Cubeddu, Roberto J.

AU - Inglessis, Ignacio

AU - Palacios, Igor F.

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N2 - Objectives To evaluate the impact of left ventricular (LV) chamber size on procedural and hospital outcomes of patients undergoing aortic valvuloplasty. Background Balloon aortic valvuloplasty (BAV) is used as an integral step during transcatheter aortic valve implantation. Patients with small, thickened ventricles are thought to have more complications during and following BAV. Methods Retrospective study of consecutive patients with severe, symptomatic calcific aortic stenosis who underwent retrograde BAV at Massachusetts General Hospital. We compared patients with left ventricular end-diastolic diameters (LVEDD) <4.0 cm (n = 31) to those with LVEDD ≥4.0 cm (n = 78). Baseline and procedural characteristics as well as clinical outcomes were compared. Multivariate logistic regression was used for the adjusted analysis. Results Patients with smaller LV chamber size were mostly women (80.7% vs. 19.4%, P < 0.01) and had a smaller body surface area (BSA), (1.61 ± 0.20 m 2 vs. 1.79 ± 0.25 m2, P < 0.01). Patients with smaller LV chamber size had higher ejection fractions and thicker ventricles. Otherwise, baseline characteristics were similar. The intraprocedural composite of death, cardiopulmonary arrest, intubation, hemodynamic collapse, and tamponade was higher for patients with LVEDD < 4.0 cm (32.3% v. 11.5%, P = 0.01). Adjusting for age, gender, BSA, LV pressure, and New York Heart Association class, LVEDD < 4.0 cm remained an independent predictor of procedural (OR 5.1, 95% CI 1.4-18.2) and in-hospital complications (OR 3.8, 95% CI 1.2-11.6). Conclusions Compared to patients undergoing BAV with LVEDD ≥4.0 cm, those with smaller LV chambers had worse procedural and in-hospital outcomes.

AB - Objectives To evaluate the impact of left ventricular (LV) chamber size on procedural and hospital outcomes of patients undergoing aortic valvuloplasty. Background Balloon aortic valvuloplasty (BAV) is used as an integral step during transcatheter aortic valve implantation. Patients with small, thickened ventricles are thought to have more complications during and following BAV. Methods Retrospective study of consecutive patients with severe, symptomatic calcific aortic stenosis who underwent retrograde BAV at Massachusetts General Hospital. We compared patients with left ventricular end-diastolic diameters (LVEDD) <4.0 cm (n = 31) to those with LVEDD ≥4.0 cm (n = 78). Baseline and procedural characteristics as well as clinical outcomes were compared. Multivariate logistic regression was used for the adjusted analysis. Results Patients with smaller LV chamber size were mostly women (80.7% vs. 19.4%, P < 0.01) and had a smaller body surface area (BSA), (1.61 ± 0.20 m 2 vs. 1.79 ± 0.25 m2, P < 0.01). Patients with smaller LV chamber size had higher ejection fractions and thicker ventricles. Otherwise, baseline characteristics were similar. The intraprocedural composite of death, cardiopulmonary arrest, intubation, hemodynamic collapse, and tamponade was higher for patients with LVEDD < 4.0 cm (32.3% v. 11.5%, P = 0.01). Adjusting for age, gender, BSA, LV pressure, and New York Heart Association class, LVEDD < 4.0 cm remained an independent predictor of procedural (OR 5.1, 95% CI 1.4-18.2) and in-hospital complications (OR 3.8, 95% CI 1.2-11.6). Conclusions Compared to patients undergoing BAV with LVEDD ≥4.0 cm, those with smaller LV chambers had worse procedural and in-hospital outcomes.

KW - aortic valve stenosis

KW - hypertrophic obstructive cardiomyopathy

KW - left ventricular hypertrophy

KW - subaortic stenosis

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