Short-term clinical and haemodynamic assessment of balloon aortic valvuloplasty in 30 elderly patients. Discrepancy between immediate and eighth-day haemodynamic values.
Recently, percutaneous aortic valvuloplasty has been considered as a possible palliative procedure in elderly patients with critical valvular stenosis in whom valve replacement is deferred or contra-indicated because of high operative risk. However, the demonstration of the efficacy of such a procedure is based on immediate post dilatation haemodynamic data and clinical improvement. The purpose of this study was to evaluate the haemodynamic consequences of this procedure on the eighth day after a post procedure haemodynamic control. Thirty consecutive patients (mean age 75 +/- 8.4 years) with long-standing aortic stenosis were treated at the time of cardiac catheterization with balloon dilatation. Of these 30 patients, 24 (mean age 76 +/- 8) underwent haemodynamic evaluation eight days after the procedure. Prevalvuloplasty examination revealed a mean aortic valve gradient (MAVG) of 82 +/- 19.9 mmHg, a mean thermodilution calculated cardiac output (CO) of 3.6 +/- 0.9 l min-1 and a mean aortic valve area (VA) of 0.37 +/- 0.14 cm2. Immediate postvalvuloplasty control showed a fall in MAVG to 44.5 +/- 16.7 mmHg (P less than or equal to 0.001), a decrease in CO to 3.3 +/- 1.4 l min-1 (NS) and an increase in VA to 0.60 +/- 0.35 cm2 (P less than or equal to 0.01). Eighth-day haemodynamic control revealed an increase in MAVG to 71 +/- 18.8 mmHg (P less than or equal to 0.001), an increase in CO to 4.1 +/- 1.3 l min-1 (P less than or equal to 0.001) and a decrease in VA down to 0.47 +/- 0.10 cm2 (P less than or equal to 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)
Grollier
G
G
Service de Cardiologie, CHU Côte de Nacre, Caen, France.
Commeau
P
P
Sesboué
B
B
Huret
B
B
Potier
J C
JC
Foucault
J P
JP
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000628:therapy*; D002114:Calcinosis / Q000628:therapy; D005260:Female; D005263:Femoral Artery / Q000293:injuries; D006439:Hemodynamics; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D010166:Palliative Care; D012016:Reference Values; D013997:Time Factors