Aortic valvuloplasty and large-bore percutaneous arterial access

Near-abolition of rheumatic heart disease in developed countries has transformed the demography of aortic stenosis (AS), which today results primarily from age-associated calcific degeneration. In the absence of aortic valve replacement (AVR), symptomatic severe AS portends a high risk of mortality that has remained largely unchanged despite advances in medical therapy. This chapter provides a comprehensive reassessment of balloon aortic valvuloplasty (BAV) and large-bore arterial access for adult patients with calcific AS in the era of transcatheter aortic valve replacement (TAVR). BAV, like its descendant TAVR, can be accomplished either via an anterograde or retrograde approach, described as the direction in which the balloon crosses the aortic valve relative to the direction of blood flow. With effective percutaneous access and closure, a patient can be mobilized within hours of BAV, or even TAVR, with little to show other than a small incision and a bandage.