Clinical follow-up after percutaneous aortic balloon valvuloplasty

Percutaneous aortic balloon valvuloplasty has been applied in a growing number of patients with severe symptomatic calcific aortic stenosis. Follow-up data from these patients have not been well characterized. In 88 patients (mean age, 80 +/- 8 years) who underwent percutaneous aortic balloon valvuloplasty, the average initial aortic valve area was 0.48 +/- 0.20 cm2, and it increased to 0.74 +/- 0.26 cm2 after dilation. The average duration of follow-up in survivors was 7.8 months. Actuarial survival at 6 and 12 months was 75% and 63%, respectively. Factors associated with subsequent death included more severe impairment from heart failure at baseline, smaller initial aortic valve area, smaller final aortic valve area, low baseline cardiac output, and low ejection fraction. Among the surviving patients, 50% had no cardiac symptoms, and 85% had improved symptoms from congestive heart failure. Percutaneous aortic balloon valvuloplasty is associated with continued increased mortality during follow-up, although symptomatic improvement in survivors is good. Percutaneous aortic balloon valvuloplasty can be considered a palliative approach for severely symptomatic patients at high risk for aortic valve operation or patients with a limited life span due to other medical problems, but it is not indicated in patients at acceptably low risk for aortic valve replacement.