Aortic Balloon Valvuloplasty: Is There Still a Role in High-risk Patients in the Era of Percutaneous Aortic Valve Replacement?

被引:19
作者
Hamid, Tahir [1 ]
Eichoefer, Jonas [1 ]
Clarke, Bernard [1 ]
Mahadevan, Vaikom S. [1 ]
机构
[1] Univ Cent Manchester, Manchester Royal Infirm, Manchester Heart Ctr, Fdn NHS Trust, Manchester, Lancs, England
关键词
LEFT-VENTRICULAR FUNCTION; STENOSIS; SURVIVAL; FAILURE; AGE;
D O I
10.1111/j.1540-8183.2010.00559.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: To assess procedural and clinical outcomes in adults with severe aortic stenosis ( AS) undergoing percutaneous aortic balloon valvuloplasty (PABV), who are considered unsuitable on initial assessment for surgical aortic valve replacement or transcatheter aortic valve implantation (TAVI). Background: Surgical valve replacement provides better outcomes than conservative treatment for patients with severe symptomatic AS; however, patients with multiple comorbidities or hemodynamic instability carry a high operative risk. While TAVI offers an alternative to surgery, not all patients are suitable. This study looks at medium-term outcomes in a series of high-risk patients undergoing PABV. Methods: Pre- and postprocedure aortic valve gradients were measured by catheterization and echocardiography. Patients were assessed for symptomatic benefit and clinical outcomes. Results: Over 4 years, 42 patients underwent PABV. Mean clinical follow-up was 8 +/- 5.8 months and survival was 63%. Mean echocardiographic aortic valve gradient fell from 84.6 +/- 27 mmHg to 51.3 +/- 16 mmHg (p < 0.05). In 29% (12/42) patients, PABV was performed as a bridge to definitive AVR. Four had surgical AVR and six had TAVI. Two had successful noncardiac surgery. Four patients died in the periprocedural period and all were in cardiogenic shock. Patients were in New York Heart Association (NYHA) class IV decreased from 60% to 5% postprocedure (p < 0.05). Conclusion: PABV is useful as a palliation or bridge to definitive therapy for treatment of patients with severe AS unsuitable for surgery. It is associated with good medium-term cardiac outcomes and enables some patients to receive definitive therapy. (J Interven Cardiol 2010;23:358-361).
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收藏
页码:358 / 361
页数:4
相关论文
共 19 条
[1]  
Aqel Raed A, 2007, J Invasive Cardiol, V19, pE238
[2]  
BANNING AP, 1993, BRIT HEART J, V70, P544
[3]   The potential of myocardial perfusion scintigraphy for risk stratification of asymptomatic patients with type 2 diabetes [J].
Bax, Jeroen J. ;
Bonow, Robert O. ;
Tschoepe, Diethelm ;
Inzucchi, Silvio E. ;
Barrett, Eugene .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 48 (04) :754-760
[4]   PROGNOSIS AFTER VALVE-REPLACEMENT IN PATIENTS WITH SEVERE AORTIC-STENOSIS AND A LOW TRANSVALVULAR PRESSURE-GRADIENT [J].
BROGAN, WC ;
GRAYBURN, PA ;
LANGE, RA ;
HILLS, LD .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1993, 21 (07) :1657-1660
[5]   EMERGENCY PERCUTANEOUS AORTIC BALLOON VALVULOPLASTY IN A NONAGENARIAN [J].
Chacko, Sanoj ;
Mamas, Mamas ;
Nair, Satheesh ;
Luckie, Matthew ;
Hamid, Tahir ;
Mahadevan, Vaikom .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2009, 57 (01) :186-186
[6]   Aortic valvuloplasty in pediatric patients substantially postpones the need for aortic valve surgery - A single-center experience of 188 patients after up to 17.5 years of follow-up [J].
Fratz, Sohrab ;
Gildein, Hans Peter ;
Balling, Gunter ;
Sebening, Walter ;
Genz, Thomas ;
Eicken, Andreas ;
Hess, John .
CIRCULATION, 2008, 117 (09) :1201-1206
[7]   Spectrum of calcific aortic valve disease - Pathogenesis, disease progression, and treatment strategies [J].
Freeman, RV ;
Otto, CM .
CIRCULATION, 2005, 111 (24) :3316-3326
[8]  
Hanzel G. S., 2006, EUROINTERVENTION SA, V1, pA3
[9]   Long-term follow-up of morbidity and mortality after aortic valve replacement with a mechanical valve prosthesis [J].
Kvidal, P ;
Bergström, R ;
Malm, T ;
Ståhle, E .
EUROPEAN HEART JOURNAL, 2000, 21 (13) :1099-1111
[10]   Observed and relative survival after aortic valve replacement [J].
Kvidal, P ;
Bergström, R ;
Hörte, LG ;
Ståhle, E .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 35 (03) :747-756