Balloon aortic valvuloplasty in elderly patients at high risk for surgery, or inoperable

Abstract

Although aortic valve replacement is undoubtedly the treatment of choice for aortic valve stenosis, balloon aortic valvuloplasty may represent the only possible treatment for some frail elderly patients who may have additional medical problems. We evaluated immediate and 1-year results of balloon aortic valvuloplasty in 86 patients > or = 80 years with severe aortic stenosis. Mean age was 84 +/- 3 years. Forty-four % were 85 years or older. Mean gradient decreased from 68 to 26 mm Hg and valve area increased from 0.53 to 0.96 cm2 (P<0.05). There were two per-procedural deaths. No local vascular complication was observed. During the follow-up (13 +/- 9 months), 27 patients died, four had repeat balloon aortic valvuloplasty and eight underwent aortic valve replacement. Persistent clinical improvement was observed in 78% of the surviving patients. One-year actuarial survival rate was 73%. Balloon aortic valvuloplasty appears to be a safe and valuable technique in cases where surgery cannot be performed or carries a very high risk.

Radiation following percutaneous balloon aortic valvuloplasty to prevent restenosis (RADAR pilot trial)

“…In our combined group of 19 patients, the overall cumulative restenosis rates were only 11% (2 of 19 patients) and 21% (4 of 19 patients) at 6 months and 1 year, respectively. Our procedural technique including retrograde approach and balloon sizing were not significantly different from previous reports [22,28,30]. In addition, our pre-and postvalvuloplasty AVAs were not significantly different from prior reports [28][29][30].…”

“…Our procedural technique including retrograde approach and balloon sizing were not significantly different from previous reports [22,28,30]. In addition, our pre-and postvalvuloplasty AVAs were not significantly different from prior reports [28][29][30]. Although our patient numbers are small, there appears to be a dose effect suggested by lower cumulative restenosis rates (11% vs. 30%) and more adequately preserved AVAs (0.80 vs. 0.63 cm 2 ) in the high-dose group when compared with the low-dose group at 1 year.…”

Aortic Balloon Valvuloplasty—Review and Case Series

“…For example in a study by Eltchaninoff et al, that involved 86 patients over the age of 80 with severe aortic stenosis, the procedural mortality rate was 2.2%, with no vascular complications occurring periprocedurally [24]. The 1-year survival rate was 73% and 78% of the surviving patients showed a long-term clinical improvement.…”

Assessing and Reducing the Cardiac Risk of Noncardiac Surgery

“…103 Nevertheless, observational case series suggest that aortic valvuloplasty can provide a short-term bridge through noncardiac surgery. 104 …”