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[Mid-term results of 50 percutaneous aortic valvuloplasties. Follow-up studies using Doppler echocardiography]
J P Lesbre1, S Bertrand, C Tribouilloy
1CHU Amiens.
Insights
Percutaneous aortic valvuloplasty offers initial improvement in aortic valve area but restenosis is common. This procedure is best for patients with surgical contraindications due to limited long-term benefits.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Echocardiography
Context:
- Aortic stenosis is a common valvular heart disease, particularly in the elderly.
- Surgical aortic valve replacement is the standard treatment, but carries risks.
- Percutaneous aortic valvuloplasty (PAV) is an alternative therapeutic option.
Purpose:
- To evaluate the 6-month efficacy and durability of percutaneous aortic valvuloplasty.
- To assess changes in transaortic pressure gradients and aortic valve area post-PAV.
- To determine the restenosis rate and long-term outcomes following PAV.
Summary:
- Initial PAV in 50 patients significantly improved aortic valve area and reduced pressure gradients.
- However, favorable results were not sustained, with 71% experiencing restenosis by 6 months.
- Mortality at 6 months was 18%, with only 18% maintaining adequate valve area.
Impact:
- PAV provides temporary relief but has limited long-term efficacy for aortic stenosis.
- The high restenosis rate suggests PAV should be reserved for patients unsuitable for surgery.
- Further research into optimizing PAV techniques or patient selection may be warranted.
Abstract:
The aim of this study was to assess the results of percutaneous aortic valvuloplasty in 50 patients (29 men and 21 women, mean age 74 years) at 6 months by Doppler echocardiography performed 24 hours before, 24 hours, 3 and 6 months after the procedure. The following parameters were compared: maximum instantaneous transaortic pressure gradient; mean gradient; aortic valve area and index of valve patency. The initial results of catheterisation and valvuloplasty were very satisfactory as the peak-to-peak and mean pressure gradients decreased by 50 per cent and the aortic valve area increased from 0.55 +/- 0.2 to 0.83 +/- 0.30 cm2 and the success rate defined as a final surface area greater than 0.75 cm2 was 84 per cent. Unfortunately, these favourable results were not sustained in most cases: restenosis, defined as a valve area of less than 0.7 cm2, was observed in 18 per cent of patients at Day 1 and 71 per cent of patients at the 6th month; the natural history of disease was little affected with a global mortality rate at 6 months of 18 per cent through cardiac failure and sudden death; only 18 per cent of patients maintained an aortic valve area of over 0.75 cm2 at 6 months. These results suggest that percutaneous aortic valvuloplasty should be reserved for patients in whom surgery is formally contra-indicated.