Andrew C Y To1, Irene Zeng, H Arthur Coverdale. 1. Green Lane Cardiovascular Service, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand. andrewcyto@gmail.com
Abstract
BACKGROUND: Patients with severe aortic stenosis, ineligible for surgical aortic valve replacement (AVR), may instead be offered balloon aortic valvuloplasty (BAV). However, initial international enthusiasm for BAV has waned due to early restenosis and symptom recurrence. METHODS: We retrospectively reviewed consecutive adult patients who had BAVs in Auckland over a 10-year period from 1997 to 2006 and recorded their clinical, echocardiographic, haemodynamic and follow-up data. RESULTS: Twenty-nine patients (17F) underwent 35 BAV procedures. There were 26 elderly patients (mean age 87; median logistic EuroSCORE 26%) and 3 patients requiring "bridging" prior to intended AVR at a later interval. Mean changes in left ventricular systolic pressure, aortic systolic pressure and mean gradient were -8%, +16% and -43%, respectively. In the 26 elderly patients, median time to death or recurrence of symptoms was nine months. There was a significant reduction in the number of cardiac-related admissions six months after BAV compared to six months before (p=0.02). Actuarial survival of the elderly patients at 6 months, 1 year and 2 years was 88%, 64%, 31%, respectively. Complications of BAV were 2 reversible neurological events, 2 haematomas and 1 pseudoaneurysm. Re-do BAVs in 5 patients on >or=2 occasions resulted in an improved median actuarial survival of 36 months. CONCLUSION: In our experience, BAV has a useful role in symptom palliation in severe aortic stenosis when surgical valve replacement is declined or inappropriate, and can be performed in selected patients with relatively few complications. Re-do BAVs in suitable patients may prolong symptom relief and survival.
BACKGROUND:Patients with severe aortic stenosis, ineligible for surgical aortic valve replacement (AVR), may instead be offered balloon aortic valvuloplasty (BAV). However, initial international enthusiasm for BAV has waned due to early restenosis and symptom recurrence. METHODS: We retrospectively reviewed consecutive adult patients who had BAVs in Auckland over a 10-year period from 1997 to 2006 and recorded their clinical, echocardiographic, haemodynamic and follow-up data. RESULTS: Twenty-nine patients (17F) underwent 35 BAV procedures. There were 26 elderly patients (mean age 87; median logistic EuroSCORE 26%) and 3 patients requiring "bridging" prior to intended AVR at a later interval. Mean changes in left ventricular systolic pressure, aortic systolic pressure and mean gradient were -8%, +16% and -43%, respectively. In the 26 elderly patients, median time to death or recurrence of symptoms was nine months. There was a significant reduction in the number of cardiac-related admissions six months after BAV compared to six months before (p=0.02). Actuarial survival of the elderly patients at 6 months, 1 year and 2 years was 88%, 64%, 31%, respectively. Complications of BAV were 2 reversible neurological events, 2 haematomas and 1 pseudoaneurysm. Re-do BAVs in 5 patients on >or=2 occasions resulted in an improved median actuarial survival of 36 months. CONCLUSION: In our experience, BAV has a useful role in symptom palliation in severe aortic stenosis when surgical valve replacement is declined or inappropriate, and can be performed in selected patients with relatively few complications. Re-do BAVs in suitable patients may prolong symptom relief and survival.