Aortic valve replacement after percutaneous valvuloplasty--an approach in otherwise inoperable patients

Abstract

Objectives: Cardiac surgery can relieve symptoms and improve the prognosis of patients with aortic stenosis. However, surgery-related morbidity and mortality are high when severe cardiac or extracardiac factors co-exist. We report the outcome of percutaneous balloon aortic valvuloplasty (BAV) as a bridge to aortic valve replacement (AVR) in temporarily inoperable patients in our institution.

Methods: All patients who, between January 2002 and December 2006, underwent a bridging percutaneous BAV and had an AVR performed 8-14 weeks later, were included in the study. Clinical and investigational data were collected retrospectively from the patients' files. Follow-up was performed by telephonic interview.

Results: Twenty-five patients were included in the analysis (median age 71.9 years). Operative risk decreased from 18.6% before BAV to less than 13% before AVR, according to the logistical European System for Cardiac Operative Risk Evaluation (EuroSCORE). Median ejection fraction (EF) was 40% before dilation compared with 44% after BAV. The necessity for BAV included acute pulmonary oedema (8%), cardiac failure (64%), cardiogenic shock (16%), syncope (8%) and EF<10% (4%). Complications included low output (28%), renal failure (20%), septic shock (4%) and cerebrovascular accident (8%). One postoperative hospital death was observed. The median length of stay in the intensive care unit (ICU) was 44 days, and the median total hospital stay was 10 days.

Conclusions: BAV used as a bridging procedure to improve cardiovascular function prior to AVR is an interesting therapeutic approach in patients with aortic stenosis and haemodynamic failure. The postoperative course after AVR was also improved in our patients.