Percutaneous balloon valvuloplasty for calcific aortic stenosis. A treatment 'sine cure'?

Abstract

Twenty-five elderly patients with calcific aortic stenosis, 12 male (48%) and 13 female (52%), mean age 74.8 +/- 7.6 years, underwent percutaneous aortic balloon valvuloplasty between March 1986 and September 1987. Twenty-two patients (88%) were in class III-IV of the New York Heart Association, 13 (52%) had a history of previous angina and 7 (28%) of syncopal attacks. All patients had been considered either unsuitable or high-risk candidates for aortic-valve replacement because of age or associated diseases. Balloons of increasing size (area ranging from 1.3 to 3.8 cm2 during inflation) were successively passed retrogradely from the femoral artery and manually inflated to 3-7 atmospheres. Inflation duration ranged from 15 to 260 s (mean 40 s). Post-dilatation there were significant changes in left ventricular peak-systolic and end-diastolic pressures (P less than 0.00001 and P less than 0.01, respectively), mean systolic aortic transvalvular gradient (from 73 to 43 mmHg, P less than 0.000001), mean systolic aortic flow (from 176 to 208 ml s-1, P less than 0.0001) and aortic valve area (from 0.47 to 0.72 cm2, P less than 0.000001). Major complications included: in-hospital deaths of two patients (8%) admitted in cardiogenic shock; left haemiplegia (4%); transient haemianopia (8%); development of grade III aortic insufficiency (4%); and persistent complete atrioventricular block (4%). Complications at the puncture-site occurred in 7 patients (28%)--including two femoral pseudoaneurysms and the need for surgical removal of a balloon remnant after rupture in one patient. No local haemorrhagic complications were observed in the latter eight procedures, performed using a 16.5 French 100-cm long arterial introducer. At a mean follow-up of 13.0 +/- 5.0 months, an important functional improvement persisted in 14 patients (56%), no major changes in pre-valvuloplasty symptoms were observed in 3 patients (12%), while five patients (20%) required surgical treatment after a successful valvuloplasty because of recurrence of symptoms (late valve restenosis). Percutaneous aortic balloon valvuloplasty is a possible palliative therapy in elderly patients with calcific aortic stenosis. However, its inherent immediate risk, limited haemodynamic result and the possible development of valve restenosis at medium-term follow-up, suggest that the application of this technique should be limited to poor surgical candidates.

Factors Predicting and Having an Impact on the Need for a Permanent Pacemaker After CoreValve Prosthesis Implantation Using the New Accutrak Delivery Catheter System

“…In our series, we found that of the 48 patients who required a permanent pacemaker, 22 patients experienced AV block during the procedure. The possible mechanisms involved include inflammation, edema, ischemia, and mechanical trauma over the interventricular septum, with the resulting consequences in the conduction system, which may be transitory as occurs with the balloon used to predilate the native valve (19). Gutiérrez et al (20) reported transitory ECG changes after implanting the Edwards-Sapien prosthesis, with the incidence of LBBB increasing from 9% at baseline to 27% after the procedure, and then falling at 1 month to 13%.…”

Transfemoral TAVI without pre-dilatation using balloon-expandable devices: a case-matched analysis

“…As stated above, adverse events have been well recognized as associated with BAV as a stand-alone treatment [29][30][31]. Whether similar rates of complications have to be expected when performing preparatory BAV prior to TAVI remains unclear since clinical sequelae often become apparent only during the further course of the patient making discrimination of causal relation difficult.…”

Aortenklappenstenose: von der Valvuloplastie zum perkutanen Klappenersatz

“…Allerdings wurde das Verfahren seinerzeit wegen der hohen prozedurbedingten Komplikationsrate [8,19,45,48,54] und der hohen Restenoserate [36,42,43] innerhalb von 6-12 Monaten als auf Risikopatienten, die nicht operativ versorgt werden konnten oder im kardiogenen Schock waren, beschränkt angesehen und in den folgenden Jahren kaum noch angewandt.…”