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Aortic percutaneous transluminal valvuloplasty in elderly patients by balloon larger than aortic anulus
Insights
Percutaneous transluminal valvuloplasty using a trefoil balloon larger than the aortic annulus significantly increased aortic valve area in elderly patients with aortic stenosis. This method offers a wider valve area without increasing complication rates compared to standard balloon valvuloplasty.
Area of Science:
- Cardiology
- Interventional Cardiology
- Valvular Heart Disease
Background:
- Calcified aortic stenosis is a common valvular heart disease in the elderly.
- Severe aortic stenosis leads to significant morbidity and mortality.
- Percutaneous transluminal valvuloplasty (PTV) is an alternative treatment option.
Purpose of the Study:
- To compare the efficacy of standard PTV with a trefoil balloon larger than the aortic annulus.
- To evaluate the impact on aortic valve area and pressure gradients.
- To assess the safety and complication rates of both methods.
Main Methods:
- Twenty-four elderly patients with calcified aortic stenosis were divided into two groups.
- Group 1: 19 mm balloon PTV (balloon smaller than annulus).
- Group 2: 25 mm trefoil balloon PTV (balloon larger than annulus).
Main Results:
- Both methods reduced aortic valve gradients and increased aortic valve area.
- The trefoil balloon group showed a significantly greater increase in aortic valve area (0.47 to 0.88 cm²) compared to the standard group (0.40 to 0.57 cm²).
- Clinical tolerance and complication rates were comparable between the two groups.
Conclusions:
- Aortic valvuloplasty using a trefoil balloon larger than the aortic annulus can achieve a wider aortic valve area.
- This technique provides a potential improvement in PTV outcomes without an increased risk of complications.
- The trefoil balloon approach may be a valuable option for selected patients with aortic stenosis.
Abstract:
Twenty-four elderly patients (79 +/- 7 years) with long-standing calcified aortic stenosis have been divided in two comparable groups of 12. The first group was treated with 19 mm balloon percutaneous transluminal valvuloplasty, where the balloon diameter was always smaller than the aortic anulus diameter. Peak-to-peak aortic valve gradient decreased from 76 +/- 32 mmHg to 30 +/- 19 (P less than .05), and the aortic valve area, calculated by Gorlin formula, increased from 0.40 +/- 0.17 cm2 to 0.57 +/- 0.17 (P less than .05). The second group was treated with a trefoil 25 mm balloon, always larger than the aortic anulus diameter. In this second group, peak-to-peak aortic valve gradient decreased from 73 +/- 34 mmHg to 23 +/- 15 (P less than .05), and aortic valve area increased from 0.47 +/- 0.14 cm2 to 0.88 +/- 0.36 (P less than .05), increasing thus more than in group I (P less than .05). Clinical tolerance to balloon inflation was not the same according to individual patients but was similar between the two groups; complications were comparable in the two groups. These results suggest that aortic valvuloplasty by trefoil balloon larger than aortic anulus can provide wider aortic valve area without increasing complication rate.