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Percutaneous Aortic Balloon Valvuloplasty in Octogenarians: Morbidity and Mortality

Stephen T. Brady, MD; Carol A. Davis, RN; William G. Kussmaul, MD; Warren K. Laskey, MD; John W. Hirshfeld Jr., MD; and Howard C. Herrmann, MD
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Requests for Reprints: Howard C. Herrmann, MD, Cardiovascular Section, Founders 9, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.

Current Author Addresses: Drs. Brady, Kussmaul, Laskey, Hirshfeld, and Herrmann, and Ms. Davis: Cardiovascular Section, Founders 9, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.

©1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(10):761-766. doi:10.7326/0003-4819-110-10-761
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Study Objective: To examine the morbidity, mortality, and hospital course of an elderly patient sample (mean age, 86 years; 95% CI, 84 to 87) having percutaneous aortic balloon valvuloplasty.

Design: Retrospective consecutive case series before and after balloon valvuloplasty.

Setting: Tertiary care referral hospital.

Patients: Consecutive sample of 26 patients aged 80 years or older with symptomatic aortic stenosis referred for balloon valvuloplasty from July 1987 to July 1988.

Measurements and Main Results: Percutaneous aortic balloon valvuloplasty reduced the transvalvular gradient from 59 (95% CI, 51 to 67) to 31 mm Hg (95% CI, 26 to 35; P < 0.0001) and increased aortic valve area from 0.45 (95% CI, 0.38 to 0.51) to 0.67 cm2 (95% CI, 0.58 to 0.76; P < 0.0001). The mean length of hospital stay for the entire study population was 11.2 days (95% CI, 7.3 to 15.2) at a total hospital charge per patient of $29 600 (95% CI, 21 050 to 38 150). For patients having procedural complications (11 complications in 8 patients), surgical procedures, or cardiogenic shock, the mean hospital stay increased to 16.2 days (95% CI, 6.2 to 26.2; P < 0.05) and the hospital charge increased to $44 400 (95% CI, 24 280 to 64 520; P < 0.01). Two patients who presented with cardiogenic shock died, and 1 patient had an aortic valve replacement before discharge. Four patients were recently discharged ( < 1 month) and follow-up was obtained in the remaining 19 patients at 6.1 months (95% CI, 4.1 to 8.1). Five more patients, including the remaining patient who presented with cardiogenic shock, died after discharge for an overall mortality of 32%. Twelve of the remaining fourteen patients had fewer symptoms and improved an average of 1.1 New York Heart Association classes (95% CI, 0.7 to 1.4; P < 0.0001).

Conclusions: Percutaneous aortic balloon valvuloplasty in patients 80 years and older improves hemodynamics and symptoms of heart failure during short-term follow-up in most patients, but overall mortality is high in this elderly patient population. Hospital charges and length of stay were much higher in patients with complications or coexisting medical illnesses. Valvuloplasty is a reasonable alternative treatment for patients with aortic stenosis who require palliative treatment of symptoms and have high surgical risk.





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