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  • Title: [Balloon valvuloplasty of calcified aortic stenosis is a realistic alternative to surgery: clinical and invasive results 17 months following the 1st or 2d dilatation].
    Author: Spielberg C, Kruck I, Linderer T, Schröder R.
    Journal: Z Kardiol; 1989 Feb; 78(2):86-94. PubMed ID: 2718560.
    Abstract:
    Aortic balloon valvuloplasty was performed in 33 elderly patients (age 60-84, mean 74 years). In six cases, repeat-valvuloplasty was performed six months later. Mean follow-up so far has been 17 months (10-24 months). Follow-up included 23 invasive controls and repeat Doppler-echocardiographic estimation of valve gradient in all patients. At valvuloplasty, peak aortic gradient was reduced from 84 +/- 27 mm Hg to 40 +/- 18 mm Hg, valve area was increased from 0.39 +/- 0.11 cm2 to 0.74 +/- 0.16 cm2. Immediately after valvuloplasty, 76% of the patients were asymptomatic or significantly improved. At follow-up, 10 patients died and 12 patients underwent surgical valve replacement. Only seven patients are still improved or asymptomatic after 1st or 2nd valvuloplasty. Invasive control six to nine months after the 1st valvuloplasty showed satisfactory results for valve gradient and valve area in only one patient. At repeat-valvuloplasty, a mean valve gradient of 29.6 +/- 12.5 mm Hg was achieved. All patients with repeat-valvuloplasty again had invasive control after six months; peak gradient then was 56 +/- 17 mm Hg. Balloon valvuloplasty of acquired aortic valve stenosis is a palliative procedure with a high restenosis-rate. At the most, aortic valve area is doubled. In our opinion, it is only indicated in patients with an unacceptable high surgical risk. Today, old age alone is no contraindication to surgical valve replacement.
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