Cor Vasa 2010, 52(7-8):413-417 | DOI: 10.33678/cor.2010.113

Balloon aortic valvuloplasty in high-risk patients with aortic stenosis

Jiří Fiedler^*, Kateřina Linhartová, Petr Hájek, Martin Malý, David Zemánek, Radka Adlová, Josef Veselka

Kardiologické oddělení, Kardiovaskulární centrum, Fakultní nemocnice Motol, Praha, Česká republika

Aim: To evaluate the outcome of balloon aortic valvuloplasty (BAV) in high-risk patients and severely symptomatic patients with calcified aortic stenosis.

Method: Our group of patients included 34 individuals with a mean age of 80.8 ± 6.0 years who, because of their ineligibility for surgical aortic valve replacement (AVR) had 35 BAV procedures for progressive symptomatology in NYHA Classes III and IV. A total of eight procedures were performed using two-balloon catheters, and 27 procedures using single balloon catheters, with subsequent division of patients into corresponding subgroups (2B and 1B). While, in one case, the procedure was complemented with catheter-based atrial septal defect occlusion, in two cases, BAV made it possible to undertake surgical valve replacement at a later time. The parameters we evaluated included the technical success rates of the procedure, their major complications, selected pre- and post-procedural echocardiographic and invasively measured hemodynamic parameters, both separately for subgroups 2B and 1B, and overall for the whole group. Other monitored parameters included in-hospital mortality, seven-month survival rates (median, range 4-12 months), and the need for an additional procedure on the aortic valve.

Results: The technical success rates were 75%, 92.6%, and 88.6% for subgroups 2B and 1B, and the whole group, respectively. Immediately after the procedure, peak gradient (PG) measured invasively on the index orifice decreased from an average 63.9 ± 23.2 to 30.8 ± 19.7 mmHg (p < 0.05). Subsequent echocardiography showed a decrease in maximum PG from an average 85.1 ± 32.7 to 54.8 ± 17.7 mmHg (p < 0.05), mean gradient from 53.9 ± 21.2 to 32.8 ± 10.8 mmHg (p < 0.05) with the aortic orifice area increasing from 0.52 ± 0.16 to 0.74 ± 0.23 cm2 (p < 0.05) and left ventricular ejection fraction rising non-significantly from 0.45 ± 0.16 to 0.48 ± 0.16 (p = NS). Overall in-hospital mortality was 25.7%, being higher in subgroup 2B (50%) as against 1B (18.5%). There was only one procedure-related death (fatal femoral artery bleeding) being also the only complication (2.9%). Survival per se and survival without the need for an additional catheter-based or surgical procedure on the index aorta during follow-up were 68.6% and 60%, respectively, being lower in subgroup 2B (25% and 12.5%) compared with subgroup 1B (81.5% and 74.1%), respectively.

Conclusion: Our results suggest that BAV is an acceptable therapeutic option in most patients with severe and symptomatic aortic stenosis not indicated for surgical treatment or catheter-based bioprosthesis implantation. A critical consideration in terms of outcome is proper selection of patients.

Keywords: Aortic stenosis; Balloon valvuloplasty; Symptomatology; Prognosis

Published: July 1, 2010  Show citation