TY - JOUR
T1 - Staged balloon aortic valvuloplasty before standard aortic valve replacement in selected patients with severe aortic valve stenosis
AU - Altarabsheh, Salah Eldien
AU - Greason, Kevin L.
AU - Schaff, Hartzell V.
AU - Suri, Rakesh M.
AU - Li, Zhuo
AU - Mathew, Verghese
AU - Joyce, Lyle D.
AU - Park, Soon J.
AU - Dearani, Joseph A.
N1 - Copyright:
Copyright 2015 Elsevier B.V., All rights reserved.
PY - 2014/4
Y1 - 2014/4
N2 - 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 cm2/m2 (range, 0.2-0.7 cm2/ m2). 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 cm2/m2 (range, 0.3-0.7 cm2/m2) (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.
AB - 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 cm2/m2 (range, 0.2-0.7 cm2/ m2). 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 cm2/m2 (range, 0.3-0.7 cm2/m2) (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.
KW - Algorithms
KW - Aortic
KW - Aortic valve stenosis/surgery/therapy
KW - Balloon valvuloplasty
KW - Calcinosis/therapy
KW - Heart valve prosthesis implantation/mortality
KW - Retrospective studies
KW - Treatment outcome
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U2 - 10.14503/THIJ-13-3298
DO - 10.14503/THIJ-13-3298
M3 - Article
C2 - 24808774
AN - SCOPUS:84898898453
SN - 0730-2347
VL - 41
SP - 152
EP - 158
JO - Texas Heart Institute Journal
JF - Texas Heart Institute Journal
IS - 2
ER -