title: Results of repeat balloon valvuloplasty for treatment of aortic stenosis in patients aged 59 to 104 years.
abstract: Balloon aortic valvuloplasty (BAV) may be considered a palliative procedure that is performed in patients who have severely symptomatic aortic stenosis and a prohibitive surgical risk. However, due to poor early survival rates, most previous studies have involved a single BAV procedure. We analyzed long-term outcomes in patients who had severe aortic stenosis and BAV that incorporated repeat procedures to maintain symptom relief and increase survival rate. We retrospectively analyzed 212 consecutive nonsurgical patients (59 to 104 years old) who had severe calcific aortic stenosis and underwent 282 cumulative BAV procedures. Demographic, procedural, and follow-up mortality data were collected. BAV was performed with single or incremental balloon dilatation to obtain a postprocedural transaortic gradient close to 1/3 of the baseline gradient. Peak transaortic gradient after BAV decreased from 55 +/- 22 to 20 +/- 11 mm Hg and aortic valve area increased from 0.6 +/- 0.2 to 1.2 +/- 0.3 cm(2). Mean follow-up duration was 32 +/- 18 months. During follow-up, 24% of patients underwent a second BAV and 9% of patients underwent a third BAV. Duration of symptom alleviation after the first, second, and third BAV procedures were 18 +/- 3, 15 +/- 4, and 10 +/- 3 months, respectively. Median survival rate after BAV was 35 months. Survival rates 1, 3, and 5 years after the procedure were 64%, 28%, and 14% respectively. Patients who underwent repeat BAV had higher 3-year survival rates than did patients who underwent 1 BAV (p = 0.01). Therefore, repeat BAV is a viable treatment strategy in nonsurgical patients who have severe calcific aortic stenosis, because it provides a median survival rate of approximately 3 years and maintains clinical improvement.
authors.affiliation: Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, New York 10029-6574, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Agarwal
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.forename: Srinivas
authors.initials: S
authors.lastname: Attanti
authors.forename: Paul C
authors.initials: PC
authors.lastname: Lee
authors.forename: Ramin
authors.initials: R
authors.lastname: Ashtiani
authors.forename: Angelica M
authors.initials: AM
authors.lastname: Steinheimer
authors.forename: Pedro R
authors.initials: PR
authors.lastname: Moreno
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000628:therapy*; D002404:Catheterization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors