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European Heart Journal 1991 12(3):451-457;
Copyright © 1991 by the European Society of Cardiology.
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© 1991 The European Society of Cardiology

Long-term follow-up of elderly patients with severe aortic stenosis treated by balloon aortic valvuloplasty. Importance of haemodynamic parameters before and after dilatation

V. LEGRAND, J. BECKERS, M. FASTREZ, P. MARCELLE, C. MARCHAL and H. E. KULBERTUS

Catheterization Laboratory, Department of Cardiology, C.H.U. Sart Tilman 4000 Liège, Belgium

Received 17 September 1989; revised 31 May 1990; .

Correspondence: Victor Legrand, MD, Department of Cardiology, C.H.U. Sart Tilman, 4000 liège, Belgium.

Abstract

Early and late prognosis after percutaneous balloon aortic valvuloplasty (PBAV) was assessed in 38 consecutive elderly patients (mean age, 78.5 ±6.1 years). Significant valve opening was achieved in 35 patients. The hospital mortality was 8% (three patients); two other patients died within the first month and three underwent aortic valve replacement. At 2 years follow-up, there were 10 additional deaths (seven cardiac deaths) and five patients had symptom recurrence managed by aortic valve replacement (3) or repeat PBAV (2). Overall, six patients underwent surgery without untoward events and six had repeat PBAV. Only two out of six patients with repeat PBAV had sustained improvement; one was referred to surgery and the remaining three died soon after the second PBAV. One- and 2-year survival were respectively 72 and 62% and percentage of survivors with persistent improvement 68 and 41%. Although aortic valve area after PBAV was associated with outcome, predictors of poor long-term prognosis were primarily related to the pre-operative haemodynamic status. Patients with pulmonary resistances >400 dynes cm–1 s–5 had the poorest outcome ({chi}2= 18.4– P<0.0001). Overall, signs of heart failure were predictors of poor long term follow-up. These data indicate that long-term success of PBAV is mainly related to the left ventricular dysfunction noted prior to intervention.

Key Words: Aortic valve stenosis • valvuloplasty • follow-up


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