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Published on: February 27, 2017
Percutaneous aortic valvuloplasty
M E Alcaino1, R Smith, R M Allan
1Department of Cardiovascular Medicine, Prince Henry Hospital, NSW.
Insights
Percutaneous aortic valvuloplasty (PAV) offers palliative relief for severe aortic stenosis in non-surgical candidates. While complications occur, PAV improves symptoms and valve function in selected patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Severe aortic stenosis poses significant risks, especially for patients ineligible for surgical aortic valve replacement.
- Palliative treatment options are crucial for improving quality of life in this high-risk population.
Purpose of the Study:
- To evaluate the short-term and long-term outcomes of percutaneous transluminal aortic valvuloplasty (PTAV) in patients with severe aortic stenosis.
- To assess the safety and efficacy of PTAV as a palliative procedure.
Main Methods:
- A retrospective follow-up study was conducted involving 18 patients (mean age 79 years) with severe aortic stenosis who were not candidates for surgery.
- Percutaneous transluminal aortic valvuloplasty (PTAV) was performed using balloon catheter techniques.
- Patient survival and symptomatic status were the primary outcome measures.
Main Results:
- PTAV significantly reduced the aortic valve pressure gradient (64.8 to 38 mmHg) and increased aortic valve area (0.4 to 0.6 cm²).
- Fifteen patients showed early symptomatic improvement (NYHA class), though seven experienced complications, including two deaths.
- Long-term follow-up (mean 13.3 months) revealed sustained improvement in six patients, with seven deaths (three cardiac, four non-cardiac).
Conclusions:
- Percutaneous transluminal aortic valvuloplasty (PTAV) serves as a valuable palliative option for carefully selected patients with severe aortic stenosis who cannot undergo aortic valve replacement.
- PTAV can improve hemodynamic parameters and functional status, offering a potential benefit in high-risk individuals.
Objective:
To determine the short-term and long-term results of percutaneous aortic valvuloplasty.
Design:
A retrospective follow-up study.
Setting:
The Cardiac Catheterisation Laboratory and Cardiovascular Medicine Unit of a teaching hospital.
Patients:
Eighteen patients with severe aortic stenosis who were not accepted for surgery; there were 11 men and 7 women, mean age 79 +/- 4.5 years.
Interventions:
Percutaneous transluminal aortic valvuloplasty (PTAV) by means of balloon catheter techniques.
Main Outcome Measures:
Patient survival and symptomatic status.
Results:
PTAV resulted in a significant decrease in the aortic valve pressure gradient from 64.8 +/- 23.2 mmHg to 38 +/- 14.7 mmHg (mean +/- SD) (P less than 0.00001) in the 18 patients and a significant increase in the mean aortic valve area from 0.4 +/- 0.16 cm2 to 0.6 +/- 0.18 cm2 (P less than 0.0001) in 14 patients. Complications occurred in seven patients; two of them, who had been in terminal heart failure with a low output state before PTAV, died. Fifteen patients improved in at least one New York Heart Association functional class early after PTAV and one patient had an aortic valve replacement. In follow-up of between 5 and 32 months (mean, 13.3 +/- 7.7 months) six patients are in a better functional class than before PTAV, one patient is in Class IV, one patient had an aortic valve replacement and seven patients died (three died of cardiac failure and four of non-cardiac causes).
Conclusions:
PTAV has a place as a palliative procedure in selected patients with aortic stenosis in whom another condition precludes aortic valve replacement.
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