Severe aortic stenosis is the most common acquired valvular disorder with significant mortality and morbidity associated with it. Balloon Aortic Valvuloplasty (BAV) is normally considered for patients who are not suitable for surgical aortic valve replacement (SAVR) and Transcatheter aortic valve insertion (TAVI). AHA and ESC recommends BAV as a bridging procedure for SAVR and TAVI due to significant morbidity and mortality associated with BAV. An international study showed largely a similar morbidity and mortality associated with both TAVI and BAV but there is minimal Australian data available to compare TAVI with BAV.

Single centre retrospective study of patients who underwent BAV, BAV bridged to TAVI and TAVI directly, from November 2018 to October 2021. We assessed the baseline demographics, procedural complications and mortality between the groups.

Twenty – six (26) patients underwent BAV, thirty-six (36) patients bridged to TAVI post BAV and 376 patients underwent TAVI directly. All patients were more than 80 years of age. Patients who underwent isolated BAV were more likely to be female (69.2% vs 50% vs 38.9% p<0.01), and were more likely to be smokers (15.4% vs 0.0% vs 3.5%, p=<0.01). All patients undergoing BAV, BAV bridged to TAVI and TAVI directly had significant reductions in their Mean Aortic Valve Gradient (p<0.01). There was no statistically significant difference in inpatient morbidity or mortality between patient groups. At six months post-procedure there was a significant difference in survival.  There was 30.8% mortality in the BAV group, 8.3% in bridged TAVI and 1.7% mortality rate in the TAVI cohort (p<0.01). Twelve-month mortality follows the same pattern 42.3% vs 13.9% vs 4.5%, (p<0.01). 

This study suggests no statistically significant difference in inpatient and peri procedural morbidity and mortality between BAV, TAVI and bridged TAVI but a significant mortality benefit at 6 and 12 months post valve insertion either directly or post BAV. TAVI either directly or bridged appears to be a better option in comparison to BAV alone. However, due to fewer procedural complications associated with BAV, it could be used more frequently as destination procedure with repetitions as well as bridging to TAVI.