Symptomatic patients with a low cardiac output and low aortic valve gradient have a poor prognosis but are at high risk for aortic valve surgery. The outcome of percutaneous balloon aortic valvuloplasty in this subgroup of patients is unclear. Therefore, 67 patients (group 1) underwent percutaneous balloon aortic valvuloplasty between December 1, 1986 and November 1, 1987 who had a low cardiac index (<2.5 liters/min per m2) and a low aortic valve gradient (≤40 mm Hg) before the procedure. The results were compared with 200 patients (group 2) who had a low cardiac index but not a low aortic valve gradient (>40 mm Hg) before the procedure and who had similar baseline presenting symptoms. After balloon aortic valvuloplasty, there was a greater decrease in aortic valve gradient in patients in group 2 than in patients in group 1 (mean ± SD −33.0 ± 16.7 mm Hg and −14.6 ± 6.9 mm Hg, respectively; p < 0.001) although there was no significant difference in improvement in estimated aortic valve area (0.31 ± 0.21 and 0.31 ± 0.22 cm2, respectively; p = NS). In-hospital mortality was 11.9% for patients in group 1 which was not significantly different from the 7.5% mortality for patients in group 2. However, the actuarial probability of survival at 12 months for patients who survived the initial hospitalization was 46% in group 1 and 64% in group 2 (p < 0.05). Moreover, at follow-up (mean 8.8 months) 64% of surviving group 1 patients displayed clinical improvement, compared with 70% of surviving group 2 patients. Although the cumulative ongoing mortality is high after balloon aortic valvuloplasty in patients with a low-output, lowgradient state, there is a subset of patients who will have sustained, symptomatic improvement.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine