STUDY OBJECTIVE: To determine the clinical variables affecting outcome after balloon aortic valvuloplasty. DESIGN: Longitudinal follow-up of consecutive case series. PATIENTS: Consecutive sample of 36 patients with severe calcific aortic stenosis, and without active infection or left ventricular mural thrombus. INTERVENTIONS: Percutaneous transluminal dilatation of the aortic valve until the peak gradient was reduced by 50% or a maximal balloon size was used. Hemodynamic measurements taken before and after dilatation. MEASUREMENTS AND MAIN RESULTS: Thirty-three patients had a successful dilatation. Eighty-nine percent (95% confidence interval [CI]. 74% to 97%) improved symptomatically at 2 weeks, but by 26 weeks only 56% (CI, 35% to 76%) remained improved (P = 0.0078). Mortality rates were high at 8 (9%) and 26 (28%) weeks. Predictors of adverse events included left ventricular ejection fraction (P = 0.04, r = 0.46), pulmonary artery systolic pressure (P = 0.048, r = 0.65), pulmonary vascular resistance (P = 0.008, r = 0.69), and right ventricular end-diastolic pressure (P = 0.009, r = 0.43) at 8 weeks and all these factors except left ventricular ejection fraction at 26 weeks. These clinical outcomes were unrelated to other cardiac or pulmonary diseases. CONCLUSIONS: Symptomatic improvement is only temporary in many patients undergoing balloon aortic valvuloplasty, and the mortality rate in the mid-term follow-up period is high. Valve surgery remains the treatment of choice for aortic stenosis in the adult.
STUDY OBJECTIVE: To determine the clinical variables affecting outcome after balloon aortic valvuloplasty. DESIGN: Longitudinal follow-up of consecutive case series. PATIENTS: Consecutive sample of 36 patients with severe calcific aortic stenosis, and without active infection or left ventricular mural thrombus. INTERVENTIONS: Percutaneous transluminal dilatation of the aortic valve until the peak gradient was reduced by 50% or a maximal balloon size was used. Hemodynamic measurements taken before and after dilatation. MEASUREMENTS AND MAIN RESULTS: Thirty-three patients had a successful dilatation. Eighty-nine percent (95% confidence interval [CI]. 74% to 97%) improved symptomatically at 2 weeks, but by 26 weeks only 56% (CI, 35% to 76%) remained improved (P = 0.0078). Mortality rates were high at 8 (9%) and 26 (28%) weeks. Predictors of adverse events included left ventricular ejection fraction (P = 0.04, r = 0.46), pulmonary artery systolic pressure (P = 0.048, r = 0.65), pulmonary vascular resistance (P = 0.008, r = 0.69), and right ventricular end-diastolic pressure (P = 0.009, r = 0.43) at 8 weeks and all these factors except left ventricular ejection fraction at 26 weeks. These clinical outcomes were unrelated to other cardiac or pulmonary diseases. CONCLUSIONS: Symptomatic improvement is only temporary in many patients undergoing balloon aortic valvuloplasty, and the mortality rate in the mid-term follow-up period is high. Valve surgery remains the treatment of choice for aortic stenosis in the adult.
Authors: Roberto J Cubeddu; Creighton W Don; Sofia A Horvath; Pritha P Gupta; Ignacio Cruz-Gonzalez; Christian Witzke; Ignacio Inglessis; Igor F Palacios Journal: Catheter Cardiovasc Interv Date: 2013-12-04 Impact factor: 2.692
Authors: Anda Bularga; Rong Bing; Anoop Sv Shah; Philip D Adamson; Miles Behan; David E Newby; Andrew Flapan; Neal Uren; Nick Cruden Journal: Open Heart Date: 2020-09