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Is there any indication for aortic valvuloplasty in the elderly?
Kent W Dauterman1, Andrew D Michaels, Thomas A Ports
1Department of Medicine, Division of Cardiology, Interventional Cardiology, Cardiovascular Research Institute, University of California San Francisco Medical Center, San Francisco, CA 94143-0124, USA. ports@medicine.ucsf.edu
The American Journal of Geriatric Cardiology
|May 7, 2003
Summary
Severe aortic stenosis in elderly patients requires intervention. Surgical valve replacement is optimal, while balloon valvuloplasty offers temporary relief for select high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Elderly patients with severe symptomatic calcific aortic stenosis have a poor prognosis with medical management alone.
- Surgical aortic valve replacement is the established optimal treatment for this demographic.
Purpose of the Study:
- To evaluate the role of balloon valvuloplasty in severe symptomatic calcific aortic stenosis, particularly as a bridge to surgical valve replacement.
- To assess the efficacy and limitations of balloon valvuloplasty in this patient population.
Main Methods:
- Review of current literature and clinical guidelines regarding aortic stenosis management.
- Analysis of outcomes associated with balloon valvuloplasty in specific high-risk patient subgroups.
Main Results:
- Balloon valvuloplasty provides symptomatic improvement but typically results in a valve area <1.0 cm2.
- Major periprocedural complications occur in approximately 5% of cases, with a high rate of restenosis within 6 months.
- Its utility is primarily as a bridge therapy for hemodynamically unstable patients, those needing emergent noncardiac surgery, or those with severe comorbidities precluding cardiac surgery.
Conclusions:
- Balloon valvuloplasty offers temporary symptomatic relief and can be a valuable bridge to aortic valve replacement in select high-risk patients.
- Current evidence does not support balloon valvuloplasty as a treatment that alters the natural history of aortic stenosis, though further randomized trials are needed.