Balloon aortic valvuloplasty (BAV) is a palliative treatment for severe aortic stenosis (AS). Restenosis after BAV can be resolved with another BAV or with TAVI. We presented our experience with BAV and the results of RADAR-SLO study where we evaluated the external beam radiation (EBRT) for prevention of restenosis.

Inclusion criteria for BAV were severe AS, increased operative risk, bridge to surgical AVR/TAVI, urgent non-cardiac surgery. The severity of AS and LV function was assessed with invasive and echocardiographic evaluation. In RADAR-SLO study we randomized patients 2:1, the first group was treated with EBRT (total dose=16Gy).

168 patients (age=82.6y, LogEurosc=22.1%) underwent BAV. After BAV we observed an increase in AVA (0.59 to 0.70cm2, p<0.05), a decrease in mean transvalvular gradient (47.8 to 38mmHg, p<0.05), without change of LV function (EF 53.3 to 54.9%, p=0.75). The most common complications involved peripheral arterial accesses (4.8%). BAV was performed in patients with CAD (N=17) concomitant with PCI and in patients with carcinoma (N=7) that underwent major non-cardiac surgery. During 6 months follow up a restenosis of dilated valve occurred (restenosis rate 59%). Recurrence of symptoms was resolved with another BAV (2 BAV N=22, 3 BAV N=3) or TAVI (N=22). During the follow up a trend towards better outcome was noted in the TAVI patients. There was no impact of EBRT on restenosis and on survival rate (2).

BAV can be utilized as a part of a complex therapy in severe AS in high risk patients. EBRT has no impact on prevention of restenosis after BAV.