Staged balloon aortic valvuloplasty before standard aortic valve replacement in selected patients with severe aortic valve stenosis. Tex Heart Inst J 2014 Apr;41(2):152-8
Date
05/09/2014Pubmed ID
24808774Pubmed Central ID
PMC4004472DOI
10.14503/THIJ-13-3298Scopus ID
2-s2.0-84898898453 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
This study evaluated preoperative balloon aortic valvuloplasty (BAV) as a technique to decrease aortic valve replacement (AVR) risk in patients who have severe symptomatic aortic valve stenosis with substantial comorbidity. We report the outcomes of 18 high-risk patients who received BAV within 180 days before AVR from November 1993 through December 2011. Their median age was 78 years (range, 51-93 yr), and there were 11 men (61%). The pre-BAV median calculated Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) was 18.3% (range, 9.4%-50.7%). Preoperative left ventricular ejection fraction measured a median of 0.23 (range, 0.05-0.68), and the median aortic valve area index was 0.4 cm(2)/m(2) (range, 0.2-0.7 cm(2)/m(2)). The median interval from BAV to AVR was 28 days (range, 1-155 d). There were no strokes or deaths after BAV; however, 4 patients (22%) required mechanical circulatory support, 3 (17%) required femoral artery operation, and 1 (6%) developed severe aortic valve regurgitation. After BAV, the median STS PROM fell to 9.1% (range, 2.6%-25.7%) (compared with pre-BAV, P <0.001). Echocardiography before AVR showed that the median left ventricular ejection fraction had improved to 0.35 (range, 0.15-0.66), and the aortic valve area index to 0.5 cm(2)/m(2) (range, 0.3-0.7 cm(2)/m(2)) (compared with pre-BAV, both P <0.05). All patients received AVR. Operative death occurred in 2 patients (11%), and combined operative death and morbidity in 7 patients (39%). Staged BAV substantially reduces the operative risk associated with AVR in selected patients.
Author List
Altarabsheh SE, Greason KL, Schaff HV, Suri RM, Li Z, Mathew V, Joyce LD, Park SJ, Dearani JAMESH terms used to index this publication - Major topics in bold
AgedAortic Valve
Aortic Valve Insufficiency
Aortic Valve Stenosis
Balloon Valvuloplasty
Echocardiography
Female
Heart Valve Prosthesis Implantation
Humans
Male
Postoperative Complications
Preoperative Care
Retrospective Studies
Risk Adjustment
Risk Factors
Severity of Illness Index
Time Factors
United States
Ventricular Function, Left
