FACTORS INFLUENCING THE OUTCOME OF BALLOON AORTIC VALVULOPLASTY IN THE ELDERLY

This study describes the short- and long-term outcome of 44 consecutive percutaneous balloon aortic valvuloplasty procedures performed in 42 elderly patients (age 77.8 ± 7 years) with calcific aortic stenosis. The initial success rate was 95%, with the peak aortic valve pressure gradient declining from a mean of 82 ± 32 mm Hg to 44 ± 23 mm Hg and aortic valve area increasing from a mean of 0.59 ± 0.15 cm2 to 0.83 ± 0.40 cm2. One procedure-related death occurred and an additional three patients died ≤30 days after balloon aortic valvuloplasty. These patients all had New York Heart Association (NYHA) class IV heart failure symptoms prior to the procedure and their mean left ventricular ejection fraction (LVEF) (28 ± 7%) was lower than that of hospital survivors (52 ± 13%) (as was their ratio of left ventricular [LV] wall thickness-to-cavity ratio [0.50 ± 0.10 versus 0.70 ± 0.15]). At the time of hospital discharge after valvuloplasty, 76% of patients were asymptomatic or markedly improved (NYHA class I or II). After a mean follow-up of 15.5 months (range 2 to 26 months), however, 10 patients had died and 15 had undergone aortic valve replacement for recurrence of NYHA class III or IV symptoms. The adjusted 1- and 2-year survivals were 0.68 and 0.62, respectively, and adjusted 2-year event-free survival was 0.25. Proportional hazard regression analysis indicated that LVEF <40% was the only variable affecting survival (p < 0.01) and was a possible indicator of event-free survival (p = 0.07). Patients with LVEF <40% had a 2-year survival of 0.36 compared with 0.80 for those with LVEF ≥40% and 2-year event-free survival was 0 versus 0.34, respectively. This study shows that balloon aortic valvuloplasty is not an effective long-term alternative for management of aortic stenosis in patients with depressed LV function. © 1990.