ORCID

0009-0006-2396-8964 (Jafar), 0009-0000-8820-2050 (Valle), 0000-0001-9627-6236 (Benza)

Document Type

Article

Publication Date

2026

DOI

10.1016/j.shj.2026.101059

Publication Title

Structural Heart

Volume

10

Issue

9

Pages

101059

Abstract

Acute valve syndrome (AVS) 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 AVS 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.

Rights

© 2026 The Authors

This is an open access article under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License.

Original Publication Citation

Saleh, O., Jafar, O., Valle, N., Yasa, S., Mostafa, S., Benza, R. L., Talreja, D. R., Peterson, B. D., & Summers, M. R. (2026). Balloon aortic valvuloplasty as a bridge therapy in acute valve syndrome: A narrative review of evidence gaps and future directions. Structural Heart, 10(9), Article 101059. https://doi.org/10.1016/j.shj.2026.101059

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