A balloon aortic valvuloplasty (BAV) is a procedure which stretches the aortic valve to improve the symptoms of aortic stenosis.
A catheter (thin, flexible tube) is inserted into an artery in your groin, and a special dye is then used so that your aortic valve will show up on X-rays. A small balloon is then inflated in the aortic valve, which helps to increase blood flow through the heart. This procedure is done under a local anaesthetic and most patients will only need to come in the day of their procedure and stay overnight.
Benefits of BAV
This procedure can help reduce the symptoms of aortic stenosis and improve heart function. This can help patients go on to have an aortic valve replacement or transcatheter aortic valve implantation (TAVI). A BAV can also help if you are waiting for heart surgery.
The procedure
During the procedure, your doctor will put a cannula (small tube) into a vein, which will help to deliver fluids and medication. A physiologist will put electrodes on to your chest, and these are attached to a heart monitor. You will then be given a local anaesthetic into the top of your leg and once your skin numb, two sheaths will be inserted. One will go into an artery and the other into a vein. A pacing wire is then inserted into the sheath in the vein which passes into your heart, which your doctor will use to increase your heart rate.
We increase your heart rate because this reduces your blood pressure and how hard your heart has to work, which makes the BAV easier to do. A catheter with a balloon attached is threaded into the sheath inserted into the artery and through to your heart, which your doctor will be guided by using fluoroscopy. Once the catheter is in place, you may have some dye injected so that your arteries and aortic valve show up more clearly on the X-ray.
It is completely normal to experience a flushing sensation, experience a salty or metallic taste in your mouth or get a headache, but this usually only lasts for a few moments. You doctor will then inflate the balloon to open up the valve, and this may be repeated up to three times. When the balloon is inflated, you might feel dizzy or uncomfortable but you should feel better very quickly. After inflating the balloon, your doctor will take out the catheter, balloon and pacing wire. Your doctor will then seal up the small incision where the sheath was inserted with an angioseal, which is then absorbed by the body over 90 days.
After the procedure
Once the procedure is complete, you will be taken to the cath lab recovery unit for observation. A drip will be put into your arm so you can be given medication and fluids, and we will also monitor your heart's rate and rhythm. Once you are well enough, we will take you back to the cardiology unit.
Before we let you go home, we will do a blood test and an echocardiogram to check your heart and kidney functions, and we will also get you to walk for a short distance to make sure that where the incision was made has healed well enough.
Follow-up appointment
The ward will arrange a follow-up appointment for you one month after your BAV, where you will have an echocardiogram to check how well your valve is working.
Aortic stenosis is the narrowing of the aortic valve, which controls the flow of blood in and out of the heart.
Important information about this procedure
Risks
Every procedure carries a certain amount of risk, and risks are different for each person. Your doctor will talk through the risks with you before you decide whether to go through with a BAV.
Some of the risks include:
- developing an abnormally slow rhythm, which may be treated by having a permanent pacemaker inserted to restore your heart's natural rhythm
- aortic regurgitation (where the aortic valve leaks, and some blood flows in the opposite direction), if the leak is severe, you may need to have open heart surgery or a TAVI procedure
- bleeding, bruising or a small haematoma (lump) where the catheter was inserted, which generally disappear either with firm pressure (bleeding) or on their own
- femoral pseudoaneurysm (swelling where the catheter was inserted because the blood vessel wall has not healed well) which can be repaired with a percutaneous injection
- fainting during or after your BAV, which we treat by lowering your head on the bed and giving you some medications through your drip
- developing a fast heart rhythm, which we revert by giving a single electrical shock to restore your heart's natural rhythm
- an allergic reaction to the dye we use for the X-ray, which is very rare. If this happens, we treat it by giving you medication through your drip
- the catheter tearing a small hole in one the chambers of the heart, which can lead to blood collecting around the heart. We treat this by draining the blood from a chest drain, but if the hole is large, we may need to operate.
- kidney function damage, which can happen if you have poor kidney function before the procedure, but we will check this beforehand. Usually, this gets better with treatment, but 1-2% of patients may need haemodialysis, where a machine is used to do the kidneys' job of cleaning the blood.
- stroke during or after the procedure
- death due to a heart condition or other complications.
These complications generally only affect 1-2% of patients, but if you have any questions or concerns, speak to your doctor.
What to do before your BAV
Before your procedure, we will ask you to come to the pre-admission clinic two to three weeks beforehand to check your general health and fitness. We will do some blood tests and also a test for MRSA. Once your health checks are complete, we will confirm your admission date. If you are already an inpatient, you won't need to attend the pre-admission clinic.
Make sure to bring all your medication with you to the pre-admission clinic, and a cardiology specialist pharmacist will give you advice about your medication at the clinic. There are some drugs that you will need to stop taking before you have a BAV:
- warfarin: stop taking this three days before your BAV
- new oral anticoagulation drugs (NOACs): stop taking these 48 hours before the procedure:
- Pradaxa (dabigatran)
- Xarelto (rivaroxaban)
- Eliquis (apixaban)
You can keep taking any other medication you are taking, but if you have any questions, you can ask your doctor, pharmacist or nurse.
Improving your health
You can help to reduce the risks associated with BAV by improving your health, and help to make the procedure more effective. You can do this by:
- Stop smoking - if you smoke, try to stop completely several weeks before your procedure, as this reduces the risk of breathing problems and help it make the procedure safer. Talk to your GP or visit SMOKEFREE for support
- Control your weight - if you are overweight, losing weight will help to reduce the risks of having a BAV. Speak to your GP or practice nurse for advice
- Visit your dentist - making sure that your teeth and gums are healthy will help to reduce the risk of infection, as germs can enter the bloodstream from the teeth and gums and get to the heart, causing a condition known as endocarditis
- Visit your GP - ask your GP for a check-up if you have any ongoing medical problems such as diabetes, asthma, bronchitis, thyroid problems or high blood pressure.
If you feel unwell before your BAV, telephone the acute cardiac care unit (ACCU) for advice.
On the morning of your BAV, contact the acute cardiac care unit (ACCU) before you leave home to make sure that a bed is available. If we need to delay your BAV for any reason we will explain what happens next.
Below is some advice that you should follow before you come in for your BAV.
Hygiene
It is very important that you have a thorough shower or bath the night before and the morning of your admission to hospital. Pay special attention to washing under skin folds such as under the breasts, the groin and genital area.
At the pre-admission clinic we will give you an antiseptic body wash to use the night before and the morning of your admission.
Do not shave or remove hair from your chest, arms, legs or groin before you come into hospital. If needed, shaving will be done in hospital just before your BAV.
Food and drink
You can have a light breakfast like cereal at 6am on the morning of your BAV. You will then be able to drink water, black tea or black coffee up until the procedure.
What to bring
It's important to bring with you:
- your completed hospital forms
- all your medication
- a dressing gown
- slippers that fit well and that have a good grip
- something to read
Coming into hospital
Please go to the main reception and ask for the admission office. An admissions officer will process your paperwork and direct you to the ward.
On the ward
When you get to the ward, a nurse will show you your bed, where you will wait for your BAV.
Male and female patients may share the same ward, but will have separate bays and bathrooms. Exceptions to this may be in intensive care and high dependency areas, where male and female patients may be cared for in the same bay.
We aim to carry out your BAV as early in the day as possible, but cannot guarantee a time. Unfortunately, there may be delays if other patients need to be seen in an emergency. Staff on the unit will keep you informed.
Remove all jewellery, dentures and hearing aids, and you will need to undress and put a hospital gown on.
You will have your BAV in the cardiac catheterisation laboratory (cath lab).
Going home after your BAV
Most patients go home the day after a BAV, but you will need to arrange for someone to take you home after your BAV. You will not be allowed to drive for one week after the procedure.
Air travel
Please ask your doctor about air travel. You can usually travel by plane seven days after your BAV.
Follow-up care
If you have any questions when you are at home, please contact the ACCU. The contact details are opposite. If you feel you need treatment urgently, contact your GP, or go to the nearest accident and emergency (A&E) department.
Useful contacts
- Adult cardiac care unit (ACCU) 01895 828 667 or 01895 828 648 (direct lines)
- Intensive therapy unit (ITU) 01895 828 682 or 01895 828 685 (direct lines)
- Woodlands pre-admission unit 01895 828 827 (Monday to Friday, 8am–4pm)
- Woodlands answer machine 01895 828 729 (24 hours)
- Cardiac rehabilitation nurses 01895 828 944 (Monday to Friday, 8am–4pm)
- Recovery unit 01895 823 737 ask for extension 5330 or 5339
- Parkwood House - visitor accommodation 01895 828 823
- Outpatients 01895 828 695