Percutaneous transluminal balloon valvuloplasty of adult aortic stenosis: Report of 92 cases

Percutaneous transluminal balloon valvuloplasty was attempted in 92 adult patients with severe calcific aortic stenosis. The mean age was 75 ± 11 years (range 38 to 91) and 35 patients were more than 80 years old. Most of the patients were severely disabled; 66 were in New York Heart Association functional class III or IV, 27 had syncopal attacks and 21 had severe angina pectoris. Because of unacceptably high surgical risk or contraindication to thoracic surgery, 42 patients could not be considered for valve replacement. Other patients either were in a category of high operative risk or refused the surgical intervention. Valvuloplasty was performed by way of the femoral route (82 patients) or the brachial route (10 patients). Catheters of size 15, 18 and 20 mm were successively placed across the aortic valve and three inflations were usually done with each of them, lasting 80 seconds on average, until a decrease in peak to peak systolic pressure gradient to 40 mm Hg or less was attained, a result considered satisfactory. The inflated balloons were not totally occlusive in most cases and clinical tolerance of inflation was good. Valvuloplasty resulted in a reduction of mean systolic gradient from 75 ± 26 to 30 ± 13 mm Hg (p < 0.001); the final gradient was less than 40 mm Hg in 78 patients. Mean calculated aortic valve area increased from 0.49 ± 0.17 to 0.93 ± 0.36 cm2 (p < 0.001). Immediately after the procedure, ejection fraction increased from 48 ± 16 to 51 ± 16% (p < 0.01). Valvuloplasty generally resulted in a minor increase in aortic insufficiency, except in two patients in whom it increased from grade 1 to 3. There was no clinical evidence of embolic phenomena. The mean hospital stay was 6 days. There were three in-hospital deaths, two due to complications of arterial catheterization and one related to insufficient valve dilation. A dramatic in-hospital clinical improvement was noted in all severely disabled patients. The mean follow-up time is now 18 ± 9 weeks (range 8 to 44). Eight patients died 4 to 12 weeks after the procedure; all but one were more than 80 years of age and were in functional class III or IV before valvuloplasty. Improvement noted before hospital discharge was sustained and marked in most of the remaining patients. Repeat catheterization performed in 12 patients, 4 to 24 weeks later, confirmed a stable hemodynamic improvement. These results suggest that aortic valvuloplasty could become a relatively simple, safe, low cost possible therapeutic procedure in patients who are not surgical candidates or in patients, mostly elderly, who are considered to be at high risk for valve replacement. © 1987, American College of Cardiology Foundation. All rights reserved.