Staged balloon aortic valvuloplasty before standard aortic valve replacement in selected patients with severe aortic valve stenosis

Salah Eldien Altarabsheh, Kevin L. Greason, Hartzell V Schaff, Rakesh M. Suri, Zhuo Li, Verghese Mathew, Lyle D. Joyce, Soon J. Park, Joseph A. Dearani

Research output: Contribution to journalArticle

3 Citations (Scopus)

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<sup>2</sup>/m<sup>2</sup> (range, 0.2-0.7 cm<sup>2</sup>/ m<sup>2</sup>). 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<sup>2</sup>/m<sup>2</sup> (range, 0.3-0.7 cm<sup>2</sup>/m<sup>2</sup>) (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.

Original languageEnglish (US)
Pages (from-to)152-158
Number of pages7
JournalTexas Heart Institute Journal
Volume41
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Balloon Valvuloplasty
Aortic Valve Stenosis
Aortic Valve
Aortic Valve Insufficiency
Mortality
Femoral Artery
Stroke Volume
Comorbidity
Thorax
Stroke
Morbidity

Keywords

  • Algorithms
  • Aortic
  • Aortic valve stenosis/surgery/therapy
  • Balloon valvuloplasty
  • Calcinosis/therapy
  • Heart valve prosthesis implantation/mortality
  • Retrospective studies
  • Treatment outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Staged balloon aortic valvuloplasty before standard aortic valve replacement in selected patients with severe aortic valve stenosis. / Altarabsheh, Salah Eldien; Greason, Kevin L.; Schaff, Hartzell V; Suri, Rakesh M.; Li, Zhuo; Mathew, Verghese; Joyce, Lyle D.; Park, Soon J.; Dearani, Joseph A.

In: Texas Heart Institute Journal, Vol. 41, No. 2, 2014, p. 152-158.

Research output: Contribution to journalArticle

Altarabsheh, Salah Eldien ; Greason, Kevin L. ; Schaff, Hartzell V ; Suri, Rakesh M. ; Li, Zhuo ; Mathew, Verghese ; Joyce, Lyle D. ; Park, Soon J. ; Dearani, Joseph A. / Staged balloon aortic valvuloplasty before standard aortic valve replacement in selected patients with severe aortic valve stenosis. In: Texas Heart Institute Journal. 2014 ; Vol. 41, No. 2. pp. 152-158.
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