title: Staged balloon aortic valvuloplasty before standard aortic valve replacement in selected patients with severe aortic valve stenosis.
abstract: This study evaluated preoperative balloon aortic valvuloplasty (BAV) as a technique to decrease aortic valve replacement (AVR) risk in patients who have severe symptomatic aortic valve stenosis with substantial comorbidity. We report the outcomes of 18 high-risk patients who received BAV within 180 days before AVR from November 1993 through December 2011. Their median age was 78 years (range, 51-93 yr), and there were 11 men (61%). The pre-BAV median calculated Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) was 18.3% (range, 9.4%-50.7%). Preoperative left ventricular ejection fraction measured a median of 0.23 (range, 0.05-0.68), and the median aortic valve area index was 0.4 cm(2)/m(2) (range, 0.2-0.7 cm(2)/m(2)). The median interval from BAV to AVR was 28 days (range, 1-155 d). There were no strokes or deaths after BAV; however, 4 patients (22%) required mechanical circulatory support, 3 (17%) required femoral artery operation, and 1 (6%) developed severe aortic valve regurgitation. After BAV, the median STS PROM fell to 9.1% (range, 2.6%-25.7%) (compared with pre-BAV, P <0.001). Echocardiography before AVR showed that the median left ventricular ejection fraction had improved to 0.35 (range, 0.15-0.66), and the aortic valve area index to 0.5 cm(2)/m(2) (range, 0.3-0.7 cm(2)/m(2)) (compared with pre-BAV, both P <0.05). All patients received AVR. Operative death occurred in 2 patients (11%), and combined operative death and morbidity in 7 patients (39%). Staged BAV substantially reduces the operative risk associated with AVR in selected patients.
authors.affiliation: Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Salah Eldien
authors.initials: SE
authors.lastname: Altarabsheh
authors.affiliation: Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.affiliation: Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.affiliation: Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Li
authors.affiliation: Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Verghese
authors.initials: V
authors.lastname: Mathew
authors.affiliation: Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Lyle D
authors.initials: LD
authors.lastname: Joyce
authors.affiliation: Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Divisions of Cardiovascular Surgery (Drs. Alta-rabsheh, Dearani, Greason, Joyce, Park, Schaff, and Suri), Biomedical Statistics and Informatics (Ms Li), and Cardiovascular Diseases (Dr. Mathew), Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020379:Risk Adjustment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left
keywords: Algorithms; aortic valve stenosis/surgery/therapy; balloon valvuloplasty, aortic; calcinosis/therapy; heart valve prosthesis implantation/mortality; retrospective studies; treatment outcome