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Charles J. Davidson - One of the best experts on this subject based on the ideXlab platform.
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Balloon aortic Valvuloplasty in adults: Failure of procedure to improve long-term survival
Journal of the American College of Cardiology, 1995Co-Authors: Eric B. Lieberman, J. Kevin Harrison, Thomas M. Bashore, Karen S. Pieper, Katherine B. Kisslo, James B. Hermiller, John Wilson, Gordon Keeler, Cynthia Pierce, Charles J. DavidsonAbstract:Objectives. This study sought to determine the long-term outcome of adult patients undergoing percutaneous balloon aortic Valvuloplasty. Background. Percutaneous balloon aortic Valvuloplasty has been offered as an alternative to aortic valve replacement for selected patients with valvular aortic stenosis. Although balloon aortic Valvuloplasty produces an immediate reduction in the transvalvular aortic gradient, a high incidence of restenosis frequently leads to recurrent symptoms. Therefore, it is unclear whether balloon aortic Valvuloplasty impacts on the long-term outcome of these patients. Methods. Clinical, hemodynamic and echocardiographic data were collected at baseline in 165 patients undergoing balloon aortic Valvuloplasty and examined for their ability to predict long-term outcome. Results. The median duration of follow-up was 3.9 years (range 1 to 6). Ninety-nine percent follow-up was achieved. During this 6-year period, 152 patients (93%) died or underwent aortic valve replacement, and 99 (60%) died of cardiac-related causes. The probability of event-free survival (freedom from death, aortic valve replacement or repeat balloon aortic Valvuloplasty) 1, 2 and 3 years after Valvuloplasty was 40%, 19% and 6%, respectively. In contrast, the probability of survival 3 years after balloon aortic Valvuloplasty in a subset of 42 patients who underwent subsequent aortic valve replacement was 84%. Survival after aortic Valvuloplasty was poor regardless of the presenting symptom, but patients with New York Heart Association functional class IV congestive heart failure had events earliest. Univariable predictors of decreased event-free survival were younger age, advanced congestive heart failure symptoms, lower ejection fraction, elevated left ventricular end-diastolic pressure, presence of coronary artery disease and increased left ventricular internal diastolic diameter. Stepwise multivariable logistic regression analysis found that only younger age and a lower left ventricular ejection fraction contributed independent adverse prognostic information (chi-square 14.89, p = 0.0006). Conclusions. Long-term event-free and actuarial survival after balloon aortic Valvuloplasty is dismal and resembles the natural history of untreated aortic stenosis. Aortic valve replacement may be performed in selected subjects with good results. However, the prognosis for the remainder of patients who are not candidates for aortic valve replacement is particularly poor.
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Aortic valve replacement in adults after balloon aortic Valvuloplasty.
Circulation, 1994Co-Authors: Eric B. Lieberman, J S Wilson, Karen S. Pieper, Katherine B. Kisslo, James E. Lowe, James M. Douglas, P. Van Trigt, Donald D. Glower, Charles J. DavidsonAbstract:BACKGROUND Percutaneous balloon aortic Valvuloplasty is limited by a high risk of procedural morbidity, transient clinical benefit, and a high restenosis rate. The management of patients with symptomatic aortic valve restenosis after percutaneous balloon aortic Valvuloplasty is unclear. We hypothesized that aortic valve replacement would produce superior midterm survival compared with repeat balloon aortic Valvuloplasty or medication alone in patients with symptomatic aortic valve restenosis after prior balloon aortic Valvuloplasty. METHODS AND RESULTS Baseline clinical, echocardiographic, and hemodynamic data were collected on 165 patients who underwent percutaneous balloon aortic Valvuloplasty as treatment for symptomatic degenerative calcific aortic stenosis. In 144 of these patients (87%), aortic valve replacement was originally considered to carry excessive risk. The survival of three subgroups was calculated during a median follow-up period of 3.9 years (range, 1 to 6 years). Ninety-four patients (57%) had no further mechanical intervention (subgroup 1-BAV), 31 patients (19%) developed symptomatic aortic valve restenosis and underwent a repeat balloon aortic Valvuloplasty (subgroup 2-BAV), and 40 patients (24%) subsequently underwent aortic valve replacement (subgroup BAV+AVR). Follow-up was 99% complete. Patients in subgroup BAV+AVR tended to be younger and have a lower prevalence of coronary artery disease or mitral regurgitation. Only 1 patient (2.5%) suffered a perioperative death during aortic valve replacement. The probability of survival 3 years from the date of the last mechanical intervention was 13% for subgroup 1-BAV, 20% for subgroup 2-BAV, and 75% for subgroup BAV+AVR. At the conclusion of follow-up, only 2 patients had symptoms of congestive heart failure or angina after aortic valve replacement. CONCLUSIONS Aortic valve replacement may be performed with a low mortality rate, excellent palliation of symptoms, and prolongation of survival in selected high-risk patients with a history of previous balloon aortic Valvuloplasty.
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Aortic valve replacement in adults after balloon aortic Valvuloplasty.
Circulation, 1994Co-Authors: Eric B. Lieberman, J S Wilson, Karen S. Pieper, Katherine B. Kisslo, P. Van Trigt, Donald D. Glower, J K Harrison, J Lowe, J Douglas, Charles J. DavidsonAbstract:Percutaneous balloon aortic Valvuloplasty is limited by a high risk of procedural morbidity, transient clinical benefit, and a high restenosis rate. The management of patients with symptomatic aortic valve restenosis after percutaneous balloon aortic Valvuloplasty is unclear. We hypothesized that aortic valve replacement would produce superior midterm survival compared with repeat balloon aortic Valvuloplasty or medication alone in patients with symptomatic aortic valve restenosis after prior balloon aortic Valvuloplasty. Baseline clinical, echocardiographic, and hemodynamic data were collected on 165 patients who underwent percutaneous balloon aortic Valvuloplasty as treatment for symptomatic degenerative calcific aortic stenosis. In 144 of these patients (87%), aortic valve replacement was originally considered to carry excessive risk. The survival of three subgroups was calculated during a median follow-up period of 3.9 years (range, 1 to 6 years). Ninety-four patients (57%) had no further mechanical intervention (subgroup 1-BAV), 31 patients (19%) developed symptomatic aortic valve restenosis and underwent a repeat balloon aortic Valvuloplasty (subgroup 2-BAV), and 40 patients (24%) subsequently underwent aortic valve replacement (subgroup BAV+AVR). Follow-up was 99% complete. Patients in subgroup BAV+AVR tended to be younger and have a lower prevalence of coronary artery disease or mitral regurgitation. Only 1 patient (2.5%) suffered a perioperative death during aortic valve replacement. The probability of survival 3 years from the date of the last mechanical intervention was 13% for subgroup 1-BAV, 20% for subgroup 2-BAV, and 75% for subgroup BAV+AVR. At the conclusion of follow-up, only 2 patients had symptoms of congestive heart failure or angina after aortic valve replacement. Aortic valve replacement may be performed with a low mortality rate, excellent palliation of symptoms, and prolongation of survival in selected high-risk patients with a history of previous balloon aortic Valvuloplasty.
Eric B. Lieberman - One of the best experts on this subject based on the ideXlab platform.
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Balloon aortic Valvuloplasty in adults: Failure of procedure to improve long-term survival
Journal of the American College of Cardiology, 1995Co-Authors: Eric B. Lieberman, J. Kevin Harrison, Thomas M. Bashore, Karen S. Pieper, Katherine B. Kisslo, James B. Hermiller, John Wilson, Gordon Keeler, Cynthia Pierce, Charles J. DavidsonAbstract:Objectives. This study sought to determine the long-term outcome of adult patients undergoing percutaneous balloon aortic Valvuloplasty. Background. Percutaneous balloon aortic Valvuloplasty has been offered as an alternative to aortic valve replacement for selected patients with valvular aortic stenosis. Although balloon aortic Valvuloplasty produces an immediate reduction in the transvalvular aortic gradient, a high incidence of restenosis frequently leads to recurrent symptoms. Therefore, it is unclear whether balloon aortic Valvuloplasty impacts on the long-term outcome of these patients. Methods. Clinical, hemodynamic and echocardiographic data were collected at baseline in 165 patients undergoing balloon aortic Valvuloplasty and examined for their ability to predict long-term outcome. Results. The median duration of follow-up was 3.9 years (range 1 to 6). Ninety-nine percent follow-up was achieved. During this 6-year period, 152 patients (93%) died or underwent aortic valve replacement, and 99 (60%) died of cardiac-related causes. The probability of event-free survival (freedom from death, aortic valve replacement or repeat balloon aortic Valvuloplasty) 1, 2 and 3 years after Valvuloplasty was 40%, 19% and 6%, respectively. In contrast, the probability of survival 3 years after balloon aortic Valvuloplasty in a subset of 42 patients who underwent subsequent aortic valve replacement was 84%. Survival after aortic Valvuloplasty was poor regardless of the presenting symptom, but patients with New York Heart Association functional class IV congestive heart failure had events earliest. Univariable predictors of decreased event-free survival were younger age, advanced congestive heart failure symptoms, lower ejection fraction, elevated left ventricular end-diastolic pressure, presence of coronary artery disease and increased left ventricular internal diastolic diameter. Stepwise multivariable logistic regression analysis found that only younger age and a lower left ventricular ejection fraction contributed independent adverse prognostic information (chi-square 14.89, p = 0.0006). Conclusions. Long-term event-free and actuarial survival after balloon aortic Valvuloplasty is dismal and resembles the natural history of untreated aortic stenosis. Aortic valve replacement may be performed in selected subjects with good results. However, the prognosis for the remainder of patients who are not candidates for aortic valve replacement is particularly poor.
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Aortic valve replacement in adults after balloon aortic Valvuloplasty.
Circulation, 1994Co-Authors: Eric B. Lieberman, J S Wilson, Karen S. Pieper, Katherine B. Kisslo, James E. Lowe, James M. Douglas, P. Van Trigt, Donald D. Glower, Charles J. DavidsonAbstract:BACKGROUND Percutaneous balloon aortic Valvuloplasty is limited by a high risk of procedural morbidity, transient clinical benefit, and a high restenosis rate. The management of patients with symptomatic aortic valve restenosis after percutaneous balloon aortic Valvuloplasty is unclear. We hypothesized that aortic valve replacement would produce superior midterm survival compared with repeat balloon aortic Valvuloplasty or medication alone in patients with symptomatic aortic valve restenosis after prior balloon aortic Valvuloplasty. METHODS AND RESULTS Baseline clinical, echocardiographic, and hemodynamic data were collected on 165 patients who underwent percutaneous balloon aortic Valvuloplasty as treatment for symptomatic degenerative calcific aortic stenosis. In 144 of these patients (87%), aortic valve replacement was originally considered to carry excessive risk. The survival of three subgroups was calculated during a median follow-up period of 3.9 years (range, 1 to 6 years). Ninety-four patients (57%) had no further mechanical intervention (subgroup 1-BAV), 31 patients (19%) developed symptomatic aortic valve restenosis and underwent a repeat balloon aortic Valvuloplasty (subgroup 2-BAV), and 40 patients (24%) subsequently underwent aortic valve replacement (subgroup BAV+AVR). Follow-up was 99% complete. Patients in subgroup BAV+AVR tended to be younger and have a lower prevalence of coronary artery disease or mitral regurgitation. Only 1 patient (2.5%) suffered a perioperative death during aortic valve replacement. The probability of survival 3 years from the date of the last mechanical intervention was 13% for subgroup 1-BAV, 20% for subgroup 2-BAV, and 75% for subgroup BAV+AVR. At the conclusion of follow-up, only 2 patients had symptoms of congestive heart failure or angina after aortic valve replacement. CONCLUSIONS Aortic valve replacement may be performed with a low mortality rate, excellent palliation of symptoms, and prolongation of survival in selected high-risk patients with a history of previous balloon aortic Valvuloplasty.
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Aortic valve replacement in adults after balloon aortic Valvuloplasty.
Circulation, 1994Co-Authors: Eric B. Lieberman, J S Wilson, Karen S. Pieper, Katherine B. Kisslo, P. Van Trigt, Donald D. Glower, J K Harrison, J Lowe, J Douglas, Charles J. DavidsonAbstract:Percutaneous balloon aortic Valvuloplasty is limited by a high risk of procedural morbidity, transient clinical benefit, and a high restenosis rate. The management of patients with symptomatic aortic valve restenosis after percutaneous balloon aortic Valvuloplasty is unclear. We hypothesized that aortic valve replacement would produce superior midterm survival compared with repeat balloon aortic Valvuloplasty or medication alone in patients with symptomatic aortic valve restenosis after prior balloon aortic Valvuloplasty. Baseline clinical, echocardiographic, and hemodynamic data were collected on 165 patients who underwent percutaneous balloon aortic Valvuloplasty as treatment for symptomatic degenerative calcific aortic stenosis. In 144 of these patients (87%), aortic valve replacement was originally considered to carry excessive risk. The survival of three subgroups was calculated during a median follow-up period of 3.9 years (range, 1 to 6 years). Ninety-four patients (57%) had no further mechanical intervention (subgroup 1-BAV), 31 patients (19%) developed symptomatic aortic valve restenosis and underwent a repeat balloon aortic Valvuloplasty (subgroup 2-BAV), and 40 patients (24%) subsequently underwent aortic valve replacement (subgroup BAV+AVR). Follow-up was 99% complete. Patients in subgroup BAV+AVR tended to be younger and have a lower prevalence of coronary artery disease or mitral regurgitation. Only 1 patient (2.5%) suffered a perioperative death during aortic valve replacement. The probability of survival 3 years from the date of the last mechanical intervention was 13% for subgroup 1-BAV, 20% for subgroup 2-BAV, and 75% for subgroup BAV+AVR. At the conclusion of follow-up, only 2 patients had symptoms of congestive heart failure or angina after aortic valve replacement. Aortic valve replacement may be performed with a low mortality rate, excellent palliation of symptoms, and prolongation of survival in selected high-risk patients with a history of previous balloon aortic Valvuloplasty.
James E. Lock - One of the best experts on this subject based on the ideXlab platform.
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the evolving role of intraoperative balloon pulmonary Valvuloplasty in valve sparing repair of tetralogy of fallot
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: David W. Brown, James E. Lock, Joshua D Robinson, Rahul H Rathod, Pedro J Del NidoAbstract:Objective The late morbidity of pulmonary regurgitation has intensified the interest in valve-sparing repair of tetralogy of Fallot. This study reviewed a single institution’s experience with valve-sparing repair and investigated the role of intraoperative balloon Valvuloplasty. Methods A retrospective chart review identified 238 patients who underwent complete primary repair of tetralogy of Fallot at less than 180 days of age. Patients were divided into 4 groups on the basis of the type of right ventricular outflow tract repair: transannular patch (n = 111), commissurotomy or standard rigid dilation (n = 71), intraoperative balloon pulmonary Valvuloplasty (n = 32), or no valvar intervention (n = 24). Results Baseline demographic and anatomic factors differed among the 4 procedural groups with substantial overlap. Among 142 patients with pulmonary valve hypoplasia ( z score, −2 to −4), 37% had valve-sparing repair. These patients had significant annular growth over time: z score increased 0.67 and 1.00 per year in the intraoperative balloon Valvuloplasty ( P P z scores were 0.58 lower for the balloon Valvuloplasty group across all time points ( P = .001). Freedom from reintervention and surgery was shorter for the balloon Valvuloplasty group than for the other groups ( P Conclusions Patients with tetralogy of Fallot and pulmonary valve hypoplasia who undergo valve-sparing repair with intraoperative balloon Valvuloplasty have significant longitudinal annular growth, with normalization of annular size over time. Despite application in patients with more hypoplastic valves, balloon Valvuloplasty resulted in similar valve growth and pulmonary regurgitation as traditional methods, but higher rates of reintervention. Although the precise role of this technique needs further refinement, it is likely to be most useful in patients with moderate pulmonary stenosis and moderate pulmonary valve dysplasia.
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Aortic wall injury as a complication of neonatal aortic Valvuloplasty: incidence and risk factors.
Circulation: Cardiovascular Interventions, 2008Co-Authors: David W. Brown, Erin C. Chong, Kimberlee Gauvreau, John F. Keane, James E. Lock, Audrey C. MarshallAbstract:BACKGROUND Transcatheter balloon aortic Valvuloplasty for critical aortic stenosis in neonates is routinely performed without recognized complication. Aortic wall injury has rarely been observed after balloon aortic Valvuloplasty, although the incidence of this complication is unstudied. We reviewed single-center data to determine the incidence of aortic injury during balloon aortic Valvuloplasty and to identify risk factors. METHODS AND RESULTS This retrospective study included all patients
Thomas M. Bashore - One of the best experts on this subject based on the ideXlab platform.
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Balloon aortic Valvuloplasty
Progress in Cardiovascular Diseases, 1997Co-Authors: Andrew Wang, J. Kevin Harrison, Thomas M. BashoreAbstract:Balloon aortic Valvuloplasty is a percutaneous, therapeutic option for patients with severe aortic stenosis, yet the effectiveness of this procedure is dependent on the morphology of the stenotic aortic valve and the respective mechanism of dilation. In younger patients with congenital aortic stenosis, acute and intermediate-term results are good. However, in adult patients, in whom degenerative aortic stenosis is the most common cause, the acute clinical and hemodynamic benefits of balloon aortic Valvuloplasty are not lasting, as restenosis occurs in most patients within 6 months. Sympatomatic relief for adults undergoing balloon aortic Valvuloplasty is only apparent in patients with normal left ventricular function, who generally are also candidates for aortic valve replacement. Furthermore, the long-term survival for adults after balloon aortic Valvuloplasty is similar to the natural history of untreated severe aortic stenosis. In this article, the mechanism of balloon aortic Valvuloplasty, as well as its clinical and hemodynamic effects, are reviewed in the context of the different morphological types of aortic stenosis. In addition, two large registries of adult patients treated with balloon aortic Valvuloplasty provide important information regarding the acute and long-term results of this procedure and are reviewed.
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Balloon aortic Valvuloplasty in adults: Failure of procedure to improve long-term survival
Journal of the American College of Cardiology, 1995Co-Authors: Eric B. Lieberman, J. Kevin Harrison, Thomas M. Bashore, Karen S. Pieper, Katherine B. Kisslo, James B. Hermiller, John Wilson, Gordon Keeler, Cynthia Pierce, Charles J. DavidsonAbstract:Objectives. This study sought to determine the long-term outcome of adult patients undergoing percutaneous balloon aortic Valvuloplasty. Background. Percutaneous balloon aortic Valvuloplasty has been offered as an alternative to aortic valve replacement for selected patients with valvular aortic stenosis. Although balloon aortic Valvuloplasty produces an immediate reduction in the transvalvular aortic gradient, a high incidence of restenosis frequently leads to recurrent symptoms. Therefore, it is unclear whether balloon aortic Valvuloplasty impacts on the long-term outcome of these patients. Methods. Clinical, hemodynamic and echocardiographic data were collected at baseline in 165 patients undergoing balloon aortic Valvuloplasty and examined for their ability to predict long-term outcome. Results. The median duration of follow-up was 3.9 years (range 1 to 6). Ninety-nine percent follow-up was achieved. During this 6-year period, 152 patients (93%) died or underwent aortic valve replacement, and 99 (60%) died of cardiac-related causes. The probability of event-free survival (freedom from death, aortic valve replacement or repeat balloon aortic Valvuloplasty) 1, 2 and 3 years after Valvuloplasty was 40%, 19% and 6%, respectively. In contrast, the probability of survival 3 years after balloon aortic Valvuloplasty in a subset of 42 patients who underwent subsequent aortic valve replacement was 84%. Survival after aortic Valvuloplasty was poor regardless of the presenting symptom, but patients with New York Heart Association functional class IV congestive heart failure had events earliest. Univariable predictors of decreased event-free survival were younger age, advanced congestive heart failure symptoms, lower ejection fraction, elevated left ventricular end-diastolic pressure, presence of coronary artery disease and increased left ventricular internal diastolic diameter. Stepwise multivariable logistic regression analysis found that only younger age and a lower left ventricular ejection fraction contributed independent adverse prognostic information (chi-square 14.89, p = 0.0006). Conclusions. Long-term event-free and actuarial survival after balloon aortic Valvuloplasty is dismal and resembles the natural history of untreated aortic stenosis. Aortic valve replacement may be performed in selected subjects with good results. However, the prognosis for the remainder of patients who are not candidates for aortic valve replacement is particularly poor.
Karen S. Pieper - One of the best experts on this subject based on the ideXlab platform.
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Balloon aortic Valvuloplasty in adults: Failure of procedure to improve long-term survival
Journal of the American College of Cardiology, 1995Co-Authors: Eric B. Lieberman, J. Kevin Harrison, Thomas M. Bashore, Karen S. Pieper, Katherine B. Kisslo, James B. Hermiller, John Wilson, Gordon Keeler, Cynthia Pierce, Charles J. DavidsonAbstract:Objectives. This study sought to determine the long-term outcome of adult patients undergoing percutaneous balloon aortic Valvuloplasty. Background. Percutaneous balloon aortic Valvuloplasty has been offered as an alternative to aortic valve replacement for selected patients with valvular aortic stenosis. Although balloon aortic Valvuloplasty produces an immediate reduction in the transvalvular aortic gradient, a high incidence of restenosis frequently leads to recurrent symptoms. Therefore, it is unclear whether balloon aortic Valvuloplasty impacts on the long-term outcome of these patients. Methods. Clinical, hemodynamic and echocardiographic data were collected at baseline in 165 patients undergoing balloon aortic Valvuloplasty and examined for their ability to predict long-term outcome. Results. The median duration of follow-up was 3.9 years (range 1 to 6). Ninety-nine percent follow-up was achieved. During this 6-year period, 152 patients (93%) died or underwent aortic valve replacement, and 99 (60%) died of cardiac-related causes. The probability of event-free survival (freedom from death, aortic valve replacement or repeat balloon aortic Valvuloplasty) 1, 2 and 3 years after Valvuloplasty was 40%, 19% and 6%, respectively. In contrast, the probability of survival 3 years after balloon aortic Valvuloplasty in a subset of 42 patients who underwent subsequent aortic valve replacement was 84%. Survival after aortic Valvuloplasty was poor regardless of the presenting symptom, but patients with New York Heart Association functional class IV congestive heart failure had events earliest. Univariable predictors of decreased event-free survival were younger age, advanced congestive heart failure symptoms, lower ejection fraction, elevated left ventricular end-diastolic pressure, presence of coronary artery disease and increased left ventricular internal diastolic diameter. Stepwise multivariable logistic regression analysis found that only younger age and a lower left ventricular ejection fraction contributed independent adverse prognostic information (chi-square 14.89, p = 0.0006). Conclusions. Long-term event-free and actuarial survival after balloon aortic Valvuloplasty is dismal and resembles the natural history of untreated aortic stenosis. Aortic valve replacement may be performed in selected subjects with good results. However, the prognosis for the remainder of patients who are not candidates for aortic valve replacement is particularly poor.
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Aortic valve replacement in adults after balloon aortic Valvuloplasty.
Circulation, 1994Co-Authors: Eric B. Lieberman, J S Wilson, Karen S. Pieper, Katherine B. Kisslo, James E. Lowe, James M. Douglas, P. Van Trigt, Donald D. Glower, Charles J. DavidsonAbstract:BACKGROUND Percutaneous balloon aortic Valvuloplasty is limited by a high risk of procedural morbidity, transient clinical benefit, and a high restenosis rate. The management of patients with symptomatic aortic valve restenosis after percutaneous balloon aortic Valvuloplasty is unclear. We hypothesized that aortic valve replacement would produce superior midterm survival compared with repeat balloon aortic Valvuloplasty or medication alone in patients with symptomatic aortic valve restenosis after prior balloon aortic Valvuloplasty. METHODS AND RESULTS Baseline clinical, echocardiographic, and hemodynamic data were collected on 165 patients who underwent percutaneous balloon aortic Valvuloplasty as treatment for symptomatic degenerative calcific aortic stenosis. In 144 of these patients (87%), aortic valve replacement was originally considered to carry excessive risk. The survival of three subgroups was calculated during a median follow-up period of 3.9 years (range, 1 to 6 years). Ninety-four patients (57%) had no further mechanical intervention (subgroup 1-BAV), 31 patients (19%) developed symptomatic aortic valve restenosis and underwent a repeat balloon aortic Valvuloplasty (subgroup 2-BAV), and 40 patients (24%) subsequently underwent aortic valve replacement (subgroup BAV+AVR). Follow-up was 99% complete. Patients in subgroup BAV+AVR tended to be younger and have a lower prevalence of coronary artery disease or mitral regurgitation. Only 1 patient (2.5%) suffered a perioperative death during aortic valve replacement. The probability of survival 3 years from the date of the last mechanical intervention was 13% for subgroup 1-BAV, 20% for subgroup 2-BAV, and 75% for subgroup BAV+AVR. At the conclusion of follow-up, only 2 patients had symptoms of congestive heart failure or angina after aortic valve replacement. CONCLUSIONS Aortic valve replacement may be performed with a low mortality rate, excellent palliation of symptoms, and prolongation of survival in selected high-risk patients with a history of previous balloon aortic Valvuloplasty.
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Aortic valve replacement in adults after balloon aortic Valvuloplasty.
Circulation, 1994Co-Authors: Eric B. Lieberman, J S Wilson, Karen S. Pieper, Katherine B. Kisslo, P. Van Trigt, Donald D. Glower, J K Harrison, J Lowe, J Douglas, Charles J. DavidsonAbstract:Percutaneous balloon aortic Valvuloplasty is limited by a high risk of procedural morbidity, transient clinical benefit, and a high restenosis rate. The management of patients with symptomatic aortic valve restenosis after percutaneous balloon aortic Valvuloplasty is unclear. We hypothesized that aortic valve replacement would produce superior midterm survival compared with repeat balloon aortic Valvuloplasty or medication alone in patients with symptomatic aortic valve restenosis after prior balloon aortic Valvuloplasty. Baseline clinical, echocardiographic, and hemodynamic data were collected on 165 patients who underwent percutaneous balloon aortic Valvuloplasty as treatment for symptomatic degenerative calcific aortic stenosis. In 144 of these patients (87%), aortic valve replacement was originally considered to carry excessive risk. The survival of three subgroups was calculated during a median follow-up period of 3.9 years (range, 1 to 6 years). Ninety-four patients (57%) had no further mechanical intervention (subgroup 1-BAV), 31 patients (19%) developed symptomatic aortic valve restenosis and underwent a repeat balloon aortic Valvuloplasty (subgroup 2-BAV), and 40 patients (24%) subsequently underwent aortic valve replacement (subgroup BAV+AVR). Follow-up was 99% complete. Patients in subgroup BAV+AVR tended to be younger and have a lower prevalence of coronary artery disease or mitral regurgitation. Only 1 patient (2.5%) suffered a perioperative death during aortic valve replacement. The probability of survival 3 years from the date of the last mechanical intervention was 13% for subgroup 1-BAV, 20% for subgroup 2-BAV, and 75% for subgroup BAV+AVR. At the conclusion of follow-up, only 2 patients had symptoms of congestive heart failure or angina after aortic valve replacement. Aortic valve replacement may be performed with a low mortality rate, excellent palliation of symptoms, and prolongation of survival in selected high-risk patients with a history of previous balloon aortic Valvuloplasty.
