[Therapy of valvular stenosis: surgical treatment vs percutaneous balloon dilatation]

Balloon valvuloplasty has been recommended as an alternative to surgery, and therefore this new procedure needs to be compared with cardiac valve replacement. In our experience with 284 consecutive patients, hospital mortality was 1.8% (including multiple valve replacement); 5 years postoperatively survival was 92%, and 94% of the patients had an embolism-free course. To investigate the efficiency of balloon valvuloplasty, this procedure was carried out under direct vision in the operating room prior to excision and replacement of the calcified aortic valve. In two-thirds of patients balloon dilatation did not have a detectable impact on valvular anatomy. In clinical reports the calculated mean aortic valve area did not exceed 1 cm2 (orifice area of the St. Jude valve No. 25 = 3.07 cm2). A good functional result can only be expected from mitral balloon valvuloplasty in the absence of sclerotic alterations of the subvalvular structures. As regards the risk of balloon valvuloplasty for the patient, hospital mortality associated with this procedure is not below that of surgical valve replacement (6.2% in the French Registry for balloon dilatation, 1.8% in our own experience for surgical patients aged over 70 years). An alarming observation is that the beneficial effect of aortic balloon valvuloplasty on the pressure gradient ceases within a relatively short period. For patients with mitral balloon dilatation the risk of arterial thromboembolism and the development of valvular regurgitation must be taken into consideration. The area of clinical application for Balloon valvuloplasty can at present be outlined as follows. The procedure is regarded as the treatment of choice only for pulmonary stenosis. For congenital and rheumatic aortic valve stenosis balloon dilatation may be a useful method for younger individuals if the cusps are not immobilized by calcified masses.(ABSTRACT TRUNCATED AT 250 WORDS)