title: Balloon aortic valvuloplasty: the Texas Heart Institute experience.
abstract: Between October 1986 and January 1989, 73 percutaneous catheter balloon aortic valvuloplasty procedures were performed in 68 adult patients (32 men and 36 women; mean age, 77 +/- 9 years) with severe symptomatic aortic stenosis. Following the procedures, significant improvements were documented in aortic valve area, mean transvalvular pressure gradient, peak-to-peak pressure gradient, left ventricular systolic pressure, radionuclide ejection fraction, and left ventricular end-systolic volume index. There were no procedure-related deaths, but 2 patients (3%) required emergency surgery for acute aortic regurgitation. During hospitalization, 4 patients had persistent symptoms (3 died; 1 subsequently underwent repeat valvuloplasty and later, valve replacement). Short-term clinical improvement was noted in 59 of 65 patients (91%). During the follow-up period (mean, 11.6 +/- 8.4 months), 22 patients died (including the 3 who died during hospitalization). Sixteen underwent aortic valve replacement (including the 2 who underwent emergency aortic valve replacement); all 16 are alive. A total of 6 patients (1 with an initial balloon aortic valvuloplasty at an outside institution) underwent repeat valvuloplasty; of those, 4 subsequently underwent aortic valve replacement, and 2 died. Of the remaining 30 patients, 27 continue to experience relief of symptoms, and 3 have clinical symptoms that have not improved or have worsened since the valvuloplasty procedure. Multivariate predictors of clinical outcome (p<0.05) included post-valvuloplasty aortic valve area, pre- and post-valvuloplasty ejection fraction, absence of coronary artery disease, and absolute change in valve area. Overall actuarial and event-free survivals were 83% and 49%, respectively, at 1 year. Although clinical improvement is frequently noted after balloon aortic valvuloplasty, the procedure is associated with a high recurrence of symptoms and restenosis. Balloon aortic valvuloplasty is at best a palliative procedure; when feasible, surgical valve replacement is the more definitive therapy.
authors.affiliation: The Department of Cardiology Research, Division of Adult Cardiology, St. Luke's Episcopal Hospital and Texas Heart Institute, and Baylor College of Medicine, Houston, Texas 77225-0269, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Ferguson
authors.forename: E P
authors.initials: EP
authors.lastname: Riuli
authors.forename: A
authors.initials: A
authors.lastname: Massumi
authors.forename: B
authors.initials: B
authors.lastname: Treistman
authors.forename: S K
authors.initials: SK
authors.lastname: Edelman
authors.forename: M V
authors.initials: MV
authors.lastname: Harlan
authors.forename: S E
authors.initials: SE
authors.lastname: Brasier
authors.forename: J P
authors.initials: JP
authors.lastname: Murgo