Balloon aortic valvuloplasty. The Texas Heart Institute experience

Between October 1986 and January 1989, 73 percutaneous catheter balloon aortic valvuloplasty procedures were performed in 68 adult patients (32 men and 36 women; mean age, 77 ± 9 years) with severe symptomatic aortic stenosis. Following the procedures, significant improvements were documented in aortic valve area, mean transvalvular pressure gradient, peak-to-peak pressure gradient, left ventricular systolic pressure, radionuclide ejection fraction, and left ventricular end-systolic volume index. There were no procedure-related deaths, but 2 patients (3%) required emergency surgery for acute aortic regurgitation. During hospitalization, 4 patients had persistent symptoms (3 died; 1 subsequently underwent repeat valvuloplasty and later, valve replacement). Short-term clinical improvement was noted in 59 of 65 patients (91%). During the follow-up period (mean, 11.6 ± 8.4 months), 22 patints died (including the 3 who died during hospitalization). Sixteen underwent aortic valve replacement (including the 2 who underwent emergency aortic valve replacement); all 16 are alive. A total of 6 patients (1 with an initial balloon aortic valvuloplasty at an outside institution) underwent repeat valvuloplasty; of those, 4 subsequently underwent aortic valve replacement, and 2 died. Of the remaining 30 patients, 27 continue to experience relief of symptoms, and 3 have clinical symptoms that have not improved or have worsened since the valvuloplasty procedure. Multivariate predictors of clinical outcome (p < 0.05) included post-valvuloplasty aortic valve area, pre- and post-valvuloplasty ejection fraction, absence of coronary artery disease, and absolute change in valve area. Overall actuarial and event-free survivals were 83% and 49%, respectively, at 1 year. Although clinical improvement is frequently noted after balloon aortic valvuloplasty, the procedure is associated with a high recurrence of symptoms and restenosis. Balloon aortic valvuloplasty is at best a palliative procedure; when feasible, surgical valve replacement is the more definitive therapy.