Percutaneous aortic valvuloplasty.

Abstract

OBJECTIVE: To determine the short-term and long-term results of percutaneous aortic valvuloplasty. DESIGN: A retrospective follow-up study. SETTING: The Cardiac Catheterisation Laboratory and Cardiovascular Medicine Unit of a teaching hospital. PATIENTS: Eighteen patients with severe aortic stenosis who were not accepted for surgery; there were 11 men and 7 women, mean age 79 +/- 4.5 years. INTERVENTIONS: Percutaneous transluminal aortic valvuloplasty (PTAV) by means of balloon catheter techniques. MAIN OUTCOME MEASURES: Patient survival and symptomatic status. RESULTS: PTAV resulted in a significant decrease in the aortic valve pressure gradient from 64.8 +/- 23.2 mmHg to 38 +/- 14.7 mmHg (mean +/- SD) (P less than 0.00001) in the 18 patients and a significant increase in the mean aortic valve area from 0.4 +/- 0.16 cm2 to 0.6 +/- 0.18 cm2 (P less than 0.0001) in 14 patients. Complications occurred in seven patients; two of them, who had been in terminal heart failure with a low output state before PTAV, died. Fifteen patients improved in at least one New York Heart Association functional class early after PTAV and one patient had an aortic valve replacement. In follow-up of between 5 and 32 months (mean, 13.3 +/- 7.7 months) six patients are in a better functional class than before PTAV, one patient is in Class IV, one patient had an aortic valve replacement and seven patients died (three died of cardiac failure and four of non-cardiac causes). CONCLUSIONS: PTAV has a place as a palliative procedure in selected patients with aortic stenosis in whom another condition precludes aortic valve replacement.