title: Percutaneous transluminal aortic valvuloplasty--the acute outcome and follow-up of 149 patients who underwent the double balloon technique.
abstract: Double balloon percutaneous transluminal aortic valvuloplasty (PTAV) was performed on 149 patients (76 male (51%), mean age 76 +/- 11 years) whose symptoms included severe congestive heart failure in 127 cases (82%), syncope in 21 (14%) and angina in six (4%). Significant changes (P less than 0.05) in peak systolic (83 +/- 36 to 38 +/- 30 mmHg) and mean gradient (68 +/- 25 to 36 +/- 21 mmHg), and aortic valve area (0.6 +/- 0.2 to 1.0 +/- 0.4 cm2) were achieved in 130/149 patients (87%). Complications included an overall in-hospital mortality of 13%, (10.0% excluding the six deaths occurring in 18 moribund patients), a neurologic deficit incidence of 3%, and surgical arterial entry site repair 3.0% (14/47) of patients. Multivariate analysis identified congestive heart failure (NYHA Class IV), left ventricular ejection fraction, cardiac output and coronary artery disease as independent variables significantly affecting in-hospital mortality. Predictors of poor long-term survival were degree of heart failure, and coronary artery disease. The cumulative probability of survival at 24 months was 52 +/- 5% (excluding non-cardiac deaths, was 66 +/- 3%). Follow-up (mean time: 16 +/- 7 months) of 130 patients discharged alive revealed 41 late deaths (26 cardiac related). Sixty-two patients (70%) were symptomatically improved; 17 patients had symptom recurrence and underwent repeat valvuloplasty, and 10 patients valve replacement. Follow-up catheterization of 18 asymptomatic patients revealed that 11 patients had silently restenosed. These data indicate that aortic valvuloplasty is a palliative therapy for elderly patients, who are poor surgical candidates, with symptomatic calcific aortic stenosis with reasonable clinical success and long-term survival when considering their clinical status, but with a significant restenosis rate.
authors.affiliation: Department of Cardiology, St. Luke's Medical Center, Milwaukee, Wisconsin.
authors.forename: G
authors.initials: G
authors.lastname: Dorros
authors.forename: R F
authors.initials: RF
authors.lastname: Lewin
authors.forename: S H
authors.initials: SH
authors.lastname: Stertzer
authors.forename: J F
authors.initials: JF
authors.lastname: King
authors.forename: B F
authors.initials: BF
authors.lastname: Waller
authors.forename: R K
authors.initials: RK
authors.lastname: Myler
authors.forename: L
authors.initials: L
authors.lastname: Mathiak
authors.forename: M
authors.initials: M
authors.lastname: Murphy
authors.forename: R E
authors.initials: RE
authors.lastname: Shaw
authors.forename: J
authors.initials: J
authors.lastname: Assa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization; D002404:Catheterization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D015993:Life Tables; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors