Staged balloon aortic valvuloplasty before standard aortic valve replacement in selected patients with severe aortic valve stenosis Journal Article

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Authors: Altarabsheh, S. E.; Greason, K. L.; Schaff, H. V.; Suri, R. M.; Li, Z; Mathew, V; Joyce, L. D.; Park, S. J.; Dearani, J. A.
Article Title: Staged balloon aortic valvuloplasty before standard aortic valve replacement in selected patients with severe aortic valve stenosis
Abstract: This study evaluated preoperative balloon aortic valvuloplasty (BAV) as a technique to decrease aortic valve replacement (AVR) risk in patients who have severe symptomatic aortic valve stenosis with substantial comorbidity. We report the outcomes of 18 high-risk patients who received BAV within 180 days before AVR from November 1993 through December 2011. Their median age was 78 years (range, 51-93 yr), and there were 11 men (61%). The pre-BAV median calculated Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) was 18.3% (range, 9.4%-50.7%). Preoperative left ventricular ejection fraction measured a median of 0.23 (range, 0.05-0.68), and the median aortic valve area index was 0.4 cm(2)/m(2) (range, 0.2-0.7 cm(2)/m(2)). The median interval from BAV to AVR was 28 days (range, 1-155 d). There were no strokes or deaths after BAV; however, 4 patients (22%) required mechanical circulatory support, 3 (17%) required femoral artery operation, and 1 (6%) developed severe aortic valve regurgitation. After BAV, the median STS PROM fell to 9.1% (range, 2.6%-25.7%) (compared with pre-BAV, P 0.001). Echocardiography before AVR showed that the median left ventricular ejection fraction had improved to 0.35 (range, 0.15-0.66), and the aortic valve area index to 0.5 cm(2)/m(2) (range, 0.3-0.7 cm(2)/m(2)) (compared with pre-BAV, both P 0.05). All patients received AVR. Operative death occurred in 2 patients (11%), and combined operative death and morbidity in 7 patients (39%). Staged BAV substantially reduces the operative risk associated with AVR in selected patients.
Journal Title: Texas Heart Institute journal
Volume: 41
Issue: 2
ISSN: 1526-6702; 0730-2347
Publisher: Unknown  
Journal Place: United States
Date Published: 2014
Start Page: 152
End Page: 158
Language: eng
DOI/URL:

10.14503/THIJ-13-3298
Notes: LR: 20161018; JID: 8214622; OID: NLM: PMC4004472; OTO: NOTNLM; epublish