Balloon valvuloplasty in adult aortic stenosis: determinants of clinical outcome.

Abstract:

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.

journal_name

Ann Intern Med

authors

Sherman W,Hershman R,Lazzam C,Cohen M,Ambrose J,Gorlin R

doi

10.7326/0003-4819-110-6-421

subject

Has Abstract

pub_date

1989-03-15 00:00:00

pages

421-5

issue

6

eissn

0003-4819

issn

1539-3704

journal_volume

110

pub_type

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