Two years' experience of percutaneous balloon valvuloplasty in aortic stenosis.
To provide an overview of our experience with percutaneous balloon valvuloplasty in aortic stenosis, the results obtained in 218 patients have been analyzed. During the two years of its use, the technique of the procedure has been subsequently modified with increasing balloon diameters, initially 15 mm, 18 mm and then 20 mm; currently, a balloon diameter of up to 23 mm or even two balloons may be used. Accordingly, in our last 70 patients, significantly larger valve orifice areas have been achieved. The mean postinterventional valve orifice area was 1.06 cm2. In 73% of the patients valve orifice area was 0.9 cm2 or greater, in 60% 1 cm2 or more. In consideration of the high prevalence of elderly, severely-ill patients in our series, the in-hospital mortality of 4.5% (ten of 218 patients) was relatively low. Nonfatal complications included stroke in three, tamponade in three, and myocardial infarction in one patient with severe coronary artery disease. In 25 patients (13%) there were bleeding complications at the site of vascular puncture, nine of which required surgical revision. Valvuloplasty usually did not result in worsening of aortic incompetence and, consequently, up to grade II regurgitation need not be considered a contraindication. Follow-up data was obtained at an average of eight months (three to 18 months) after the procedure in the first 148 patients. During this period, 24 patients had died, 19 of whom were in functional class IV and all of whom had impaired left ventricular function and residual severe aortic stenosis after the procedure. Most of the survivors were stable and had marked clinical improvement.(ABSTRACT TRUNCATED AT 250 WORDS)
Cribier
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Service des Soins Intensifs Cardiologiques, Hôpital Charles Nicolle, Rouen, France.
Letac
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D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000628:therapy*; D021721:Balloon Occlusion; D002404:Catheterization; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D012008:Recurrence; D013997:Time Factors