Copyright © 1988 by the European Society of Cardiology.
© 1988 The European Society of Cardiology
Percutaneous balloon valvuloplasty for calcific aortic stenosis. A treatment ‘sine cure’?
Thoraxcenter, Department of Cardiology, Erasmus University Rotterdam, The Netherlands
*Pathology Department 1, University Hospital Dijkzigt Rotterdam, The Netherlands
Received 16 December 1987; revised 25 March 1988; .
Address for Correspondence: Patrick W. Serruys, M.D., F.A.C.C., Thoraxcenter, Erasmus University, Cardiac Catheterization Laboratory, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
Abstract
Twenty-five elderly patients with calcific aortic stenosis, 12 made (48%) and 13 female (52%), mean age 74.8±7.6 years, underwent percutaneous aortic balloon valvuloplasty between March 1986 and September 1987. Twenty-two patients (88%) were in class III–IV of the New York Heart Association, 13 (52%) had a history of previous angina and 7 (28%) of syncopal attacks. All patients has been considered either unsuitable or high-risk candidates for aortic-valve replacement because of age or associated diseases. Balloons of increasing size (area ranging from 1.3 to 3.8 cm2 during inflation) were successively passed retrogradely from the femoral artery and manually inflated to 3–7 atmospheres. Inflation duration ranged from 15 to 260 s (mean 40 s). Post-dilatation there were significant changes in left ventricular peak-systolic and end-diastolic pressures (P<0.00001 and P<0.01, respectively), mean systolic aortic transvalvular gradient (from 73 to 43 mm Hg, P<0.000001). Major complications included: in-hospital deaths of two patients (8%) admitted in cardiogenic shock; left haemiplegia (4%); transient haemianopia (8%); development of grade III aortic insufficiency (4%); and presistent complete atrioventricular block (4%). Complications at the puncture-site occurred in 7 patients (28%)—including two femoral pseudoaneurysms and the need for surgical removal of a balloon remnant after rupture in one patient. No local haemorrhagic complications were observed in the latter eight procedures, performed using a 16.5 French 100-cm long arterial introducer. At a mean follow-up of 13.0±5.0 months, an important functional improvement persisted in 14 patients (56%), no major changes in pre-valvuloplastry symptoms were observed in 3 patients (12%), while five patients (20%) required surgical treatment after a successful valvuloplasty because of recurrence of symptoms (late valve restenosis). Percutaneous aortic balloon valvuloplasty is a possible palliative theraphy in elderly patients with calcific aortic stenosis. However, its inherent immediate risk, limited haemodynamic result and the possible development of valve restenosis at medium-term follow-up, suggest that the application of this technique should be limited to poor surgical candidated.
Key Words: Aortic valvuloplasty • complications • follow-up.
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