Three-year outcome after balloon aortic valvuloplasty: Insights into prognosis of valvular aortic stenosis

Catherine M. Otto, Mary C. Mickel, J. Ward Kennedy, Edwin L. Alderman, Thomas M. Bashore, Peter C. Block, Jeffrey A. Brinker, Daniel Diver, James Ferguson, David Holmes, Costas T. Lambrew, Charles R. McKay, Igor F. Palacios, Eric R. Powers, Shahbudin H. Rahimtoola, Bonnie H. Weiner, Kathryn B. Davis

Research output: Contribution to journalArticle

338 Citations (Scopus)

Abstract

Background: To identify predictors of long-term outcome after balloon aortic valvuloplasty, we analyzed data on 674 adults (mean age, 78±9 years; 56% were women) undergoing this procedure at 24 clinical centers who had a mean initial increase in aortic valve area of 0.3 cm2. Methods and Results: Baseline data included clinical, echocardiographic, and catheterization variables. Follow-up data included mortality, cause of death, rehospitalization, 6-month echocardiography, and functional status. Kaplan- Meier curves and log-rank tests were used to evaluate survival in subgroups. Multivariate Cox regression models were used to identify independent predictors of survival. Overall survival was 55% at 1 year, 35% at 2 years, and 23% at 3 years, with the majority of deaths (70%) classified as cardiac by an independent review committee. Rehospitalization was common (64%), although 61% of survivors at 2 years reported improved symptoms. Echocardiography at 6 months (n = 115) showed restenosis from the postprocedural valve area of 0.78±0.31 cm2 to 0.65±0.25 cm2 (P<.0001). With stepwise multivariate analysis, sequentially adding clinical, echocardiographic, and catheterization variables, the overall model identified independent predictors of survival as baseline functional status, baseline cardiac output, renal function, cachexia, female gender, left ventricular systolic function, and mitral regurgitation. Baseline and postprocedural variables were examined to identify which subgroup of patients has the best outcome after aortic valvuloplasty. A 'lower-risk' subgroup (28% of the study population), defined by normal left ventricular systolic function and mild clinical functional limitation, had a 3-year survival of 36% compared with 17% in the remainder of the study group. Conclusions: Long- term survival after balloon aortic valvuloplasty is poor with 1- and 3-year survival rates of 55% and 23%, respectively. Although survivors report fewer symptoms, early restenosis and recurrent hospitalization are common.

Original languageEnglish (US)
Pages (from-to)642-650
Number of pages9
JournalCirculation
Volume89
Issue number2
DOIs
StatePublished - Jan 1 1994
Externally publishedYes

Fingerprint

Balloon Valvuloplasty
Aortic Valve Stenosis
Survival
Left Ventricular Function
Catheterization
Survivors
Echocardiography
Cachexia
Mitral Valve Insufficiency
Advisory Committees
Aortic Valve
Proportional Hazards Models
Cardiac Output
Cause of Death
Hospitalization
Multivariate Analysis
Survival Rate
Kidney
Mortality
Population

Keywords

  • echocardiography
  • heart disease
  • mortality
  • stenoses
  • valves

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Otto, C. M., Mickel, M. C., Kennedy, J. W., Alderman, E. L., Bashore, T. M., Block, P. C., ... Davis, K. B. (1994). Three-year outcome after balloon aortic valvuloplasty: Insights into prognosis of valvular aortic stenosis. Circulation, 89(2), 642-650. https://doi.org/10.1161/01.CIR.89.2.642

Three-year outcome after balloon aortic valvuloplasty : Insights into prognosis of valvular aortic stenosis. / Otto, Catherine M.; Mickel, Mary C.; Kennedy, J. Ward; Alderman, Edwin L.; Bashore, Thomas M.; Block, Peter C.; Brinker, Jeffrey A.; Diver, Daniel; Ferguson, James; Holmes, David; Lambrew, Costas T.; McKay, Charles R.; Palacios, Igor F.; Powers, Eric R.; Rahimtoola, Shahbudin H.; Weiner, Bonnie H.; Davis, Kathryn B.

In: Circulation, Vol. 89, No. 2, 01.01.1994, p. 642-650.

Research output: Contribution to journalArticle

Otto, CM, Mickel, MC, Kennedy, JW, Alderman, EL, Bashore, TM, Block, PC, Brinker, JA, Diver, D, Ferguson, J, Holmes, D, Lambrew, CT, McKay, CR, Palacios, IF, Powers, ER, Rahimtoola, SH, Weiner, BH & Davis, KB 1994, 'Three-year outcome after balloon aortic valvuloplasty: Insights into prognosis of valvular aortic stenosis', Circulation, vol. 89, no. 2, pp. 642-650. https://doi.org/10.1161/01.CIR.89.2.642
Otto, Catherine M. ; Mickel, Mary C. ; Kennedy, J. Ward ; Alderman, Edwin L. ; Bashore, Thomas M. ; Block, Peter C. ; Brinker, Jeffrey A. ; Diver, Daniel ; Ferguson, James ; Holmes, David ; Lambrew, Costas T. ; McKay, Charles R. ; Palacios, Igor F. ; Powers, Eric R. ; Rahimtoola, Shahbudin H. ; Weiner, Bonnie H. ; Davis, Kathryn B. / Three-year outcome after balloon aortic valvuloplasty : Insights into prognosis of valvular aortic stenosis. In: Circulation. 1994 ; Vol. 89, No. 2. pp. 642-650.
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AU - Diver, Daniel

AU - Ferguson, James

AU - Holmes, David

AU - Lambrew, Costas T.

AU - McKay, Charles R.

AU - Palacios, Igor F.

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N2 - Background: To identify predictors of long-term outcome after balloon aortic valvuloplasty, we analyzed data on 674 adults (mean age, 78±9 years; 56% were women) undergoing this procedure at 24 clinical centers who had a mean initial increase in aortic valve area of 0.3 cm2. Methods and Results: Baseline data included clinical, echocardiographic, and catheterization variables. Follow-up data included mortality, cause of death, rehospitalization, 6-month echocardiography, and functional status. Kaplan- Meier curves and log-rank tests were used to evaluate survival in subgroups. Multivariate Cox regression models were used to identify independent predictors of survival. Overall survival was 55% at 1 year, 35% at 2 years, and 23% at 3 years, with the majority of deaths (70%) classified as cardiac by an independent review committee. Rehospitalization was common (64%), although 61% of survivors at 2 years reported improved symptoms. Echocardiography at 6 months (n = 115) showed restenosis from the postprocedural valve area of 0.78±0.31 cm2 to 0.65±0.25 cm2 (P<.0001). With stepwise multivariate analysis, sequentially adding clinical, echocardiographic, and catheterization variables, the overall model identified independent predictors of survival as baseline functional status, baseline cardiac output, renal function, cachexia, female gender, left ventricular systolic function, and mitral regurgitation. Baseline and postprocedural variables were examined to identify which subgroup of patients has the best outcome after aortic valvuloplasty. A 'lower-risk' subgroup (28% of the study population), defined by normal left ventricular systolic function and mild clinical functional limitation, had a 3-year survival of 36% compared with 17% in the remainder of the study group. Conclusions: Long- term survival after balloon aortic valvuloplasty is poor with 1- and 3-year survival rates of 55% and 23%, respectively. Although survivors report fewer symptoms, early restenosis and recurrent hospitalization are common.

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