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Balloon Valvuloplasty in Adult Aortic Stenosis: Determinants of Clinical Outcome

Warren Sherman, MD; Ronnie Hershman, MD; Charles Lazzam, MD; Marc Cohen, MD; John Ambrose, MD; and Richard Gorlin, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Warren Sherman, MD, Division of Cardiology, Mount Sinai Hospital, One Gustave Levy Place, New York, NY 10029.

Current Author Addresses: Drs. Sherman, Hershman, Cohen, Ambrose, and Gorlin: Division of Cardiology, Mount Sinai Hospital, One Gustave Place, New York, NY 10029.

Dr. Lazzam: Toronto General Hospital, Eaton Building, 200 Elizabeth Street, Toronto, Ontario, Canada M5G ZC4.

©1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(6):421-425. doi:10.7326/0003-4819-110-6-421
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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.





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