Copyright © 1990 by the European Society of Cardiology.
© 1990 The European Society of Cardiology
Percutaneous transluminal aortic valvuloplasty— The acute outcome and follow-up of 149 patients who underwent the double balloon technique
*Department of Cardiology, St. Luke's Medical Center ilwaukee, Wisconsin
San Francisco Heart Institute, Seton Medical Center Daly City, California
Department of Pathology, University Hospital, Indiana University medical center Indianapolis, Indiana, U.S.A.
Received 12 October 1989; revised 23 December 1989; .
1Address fpr reprints: Gerald Dorros, M.D., St. Luke's Health Science Building, 2901 W. Kinnickinnic River Parway, Suite 512, Milwaukee, Wisconsis 53215. U.S.A.
Abstract
Double balloon percutaneous transluminal aortic valvuloplasty (PTAV) was performed on 149 patients (76 male (51%), mean age 76±11 years) whose symptoms included severe congestive heart failure in 127 cases (82%), syncope in 21 (14%) and angina in six (4%). Significant changes (P<005) in peak systolic (83 ±36 to 38 ± 30 mmHg) and mean gradient (68 ±25 to 36 ±21 mmHg), and aortic valve area (0–6 + 0–2 to 1–0 + 0–4 cm2) were achieved in 130/149 patients (87%). Complications included an overall in-hospital mortality of 13%, (100% excluding the six deaths occurring in 18 moribund patients), a neurologic deficit incidence of 3%, and surgical arterial entry site repair 30% (14/447) of patients. Multivariate analysis identified congestive heart failure (NYHA Class IV), left ventricular ejection fraction, cardiac output and coronary artery disease as independent variables significantly affecting in-hospital mortality. Predictors of poor long-term survival were degree of heart failure, and coronary artery disease. The cumulative probability of survival at 24 months was 52 ±5% (excluding non-cardiac deaths, was 66 ± 3% ). Follow-up (mean time: 16+7 months) of 130 patients discharged alive revealed 41 late deaths (26 cardiac related). Sixty-two patients (70%) were symptomatically improved; 17patients had symptom recurrence and underwent repeat valvuloplasty, and 10 patients valve replacement. Follow-up catheterizalion of 18 asymptomatic patients revealed that 11 patients had silently restenosed. These data indicate that aortic valvuloplasty is a palliative therapy for elderly patients, who are poor surgical candidates, with symptomatic calcific aortic stenosis with reasonable clinical success and long-term survival when considering their clinical status, but with a significant restenosis rate.
Key Words: Balloon aortic valvuloplasty • calcific aortic stenosis
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