Percutaneous aortic balloon valvuloplasty (PABV) was developed to provide a less invasive alternative to aortic valve replacement. Despite initially favorable results, PABV has not produced reliable and durable outcomes. The Inoue balloon used for PABV via an antegrade transseptal approach may offer an improvement over the Mansfield balloons via the identical route. Thirteen consecutive patients with severe symptomatic aortic stenosis were referred for percutaneous aortic balloon valvuloplasty. All patients were considered unacceptably high-risk surgical candidates. Seven consecutive patients underwent antegrade transseptal PABV with Mansfield balloons and in the following six the Inoue balloon was used. The study group was characterized by advanced age (mean, 77) and multiple comorbid conditions (mean, 2.5/patient). Before PABV, the two groups did not differ with respect to age, mean NYHA class, LVEF, transaortic gradient, cardiac output, or aortic valve area. All patients had initial hemodynamic improvement. Complications included one stroke and one vascular injury. After valvuloplasty, cardiac output was not significantly changed. However, there was a significant decrease in aortic gradient and an increase in aortic valve area in both groups; the increase in aortic valve area was significantly greater in those treated with the Inoue balloon (P = 0. 039). Total follow-up mortality was high but appeared to be delayed in the Inoue group. The use of the Inoue balloon with an antegrade transseptal approach warrants further investigation as a preferred technique for PABV.