Warren Sherman, MD; Ronnie Hershman, MD; Charles Lazzam, MD; Marc Cohen, MD; John Ambrose, MD; Richard Gorlin, MD
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.
Sherman W, Hershman R, Lazzam C, Cohen M, Ambrose J, Gorlin R. Balloon Valvuloplasty in Adult Aortic Stenosis: Determinants of Clinical Outcome. Ann Intern Med. ;110:421–425. doi: 10.7326/0003-4819-110-6-421
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Published: Ann Intern Med. 1989;110(6):421-425.
Cardiology, Valvular Heart Disease.
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