Intraoperative valvuloplasty in calcific aortic stenosis: a study comparing the mechanism of a novel expandable device with conventional balloon dilatation.
In selected patients with calcific aortic stenosis, balloon valvuloplasty is an intermediate alternative to surgery. The effect of balloon valvuloplasty to increase valve area, however, is limited and the restenosis rate is high during follow-up. To improve the results and reduce the complication rate, a new device for valvuloplasty of calcific aortic stenosis was developed. This system consists of three expandable prongs mounted on a freely movable catheter tip. To evaluate the efficacy of this new device, valvuloplasty was performed in 10 patients with severe aortic stenosis intraoperatively just prior to valve replacement. Comparison was made with the results of conventional balloon dilatation performed in an additional 20 patients during surgery. Using the new device, the relative orifice area increased from 10 +/- 3% before to 20 +/- 6% following intervention. However, in only one patient was a considerable increase of static valve area (greater than 15%) found. The results were comparable to the effect of conventional balloon dilatation, which led to an increase of orifice area from 12 +/- 7% to 24 +/- 10%. With both systems, the best results were achieved in patients with aortic stenosis and significant commissural fusion. In contrast, in bicuspid or tricuspid valves without fused commissures the effect of the intervention was limited. Because complete obstruction of the aortic valve does not occur during dilatation, this new device might be superior to conventional balloon dilatation. Preselection of patients according to the morphology of the valve seems mandatory to improve the success and reduce the complication rate of valvuloplasty in aortic stenosis.
Voelker
W
W
Department of Cardiology, Eberhard Karls University, Tuebingen, Germany.
Seboldt
H
H
Michel
J
J
Fenchel
G
G
Mauser
M
M
Hoffmeister
H M
HM
Karsch
K R
KR
D000368:Aged; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000628:therapy*; D002114:Calcinosis / Q000473:pathology / Q000628:therapy*; D006328:Cardiac Catheterization; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged