Balloon Aortic Valvuloplasty as a Bridge Therapy in Acute Valve Syndrome: A Narrative Review of Evidence Gaps and Future Directions.

Authors

Omar Saleh, Omar Jafar, Nicholas Valle, Shirish Yasa, Saleh Mostafa, Raymond L Benza, Deepak R Talreja, Benjamin D Peterson, Matthew R Summers

Published in

Structural heart : the journal of the Heart Team. Volume 10. Issue 9. Pages 101059. Epub Jun 23, 2026.

Abstract

Acute valve syndrome represents a high-acuity, decompensated presentation of severe aortic stenosis (AS), often manifesting as acute heart failure, cardiogenic shock, or cardiac arrest. Transcatheter aortic valve replacement (TAVR) remains the only durable therapy for severe AS in patients with prohibitive surgical risk, yet acute valve syndrome patients may be too unstable for standard preprocedural planning. Balloon aortic valvuloplasty (BAV) has re-emerged as a bridge strategy that can provide rapid hemodynamic stabilization and permit subsequent valve replacement. Registry analyses report lower mortality in emergent TAVR compared with BAV, but these comparisons are confounded by procedural indication and unmatched AS severity. Smaller hemodynamically characterized cohorts suggest that selected patients who stabilize after BAV and proceed to TAVR may achieve outcomes comparable to direct TAVR, although these studies remain underpowered for definitive inference. In this narrative review, we evaluate evidence comparing BAV-bridged strategies with emergent TAVR, identify key evidence gaps, and discuss how acute hemodynamic status may inform Heart Team decision-making.

PMID:
42633108
Bibliographic data and abstract were imported from PubMed on 23 Aug 2026.

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