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Balloon valvuloplasty in calcified aortic stenosis: a cause for caution and alarm
F Robicsek1, N B Harbold, H K Daugherty
1Carolinas Heart Institute, Charlotte, NC.
Insights
Balloon valvuloplasty for calcified aortic stenosis showed minimal impact on aortic valve function. This percutaneous procedure is not a substantial alternative to surgery for most patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Valvular Heart Disease
Background:
- Percutaneous balloon dilation is proposed as an alternative to surgical intervention for calcified aortic valvular stenosis.
- The efficacy of balloon valvuloplasty in improving aortic valve function requires thorough investigation.
Purpose of the Study:
- To evaluate the effectiveness of balloon valvuloplasty in managing calcified aortic valvular stenosis.
- To assess the impact of balloon dilation on the functional aortic orifice size.
Main Methods:
- Balloon valvuloplasty was performed under direct vision in 30 patients immediately before aortic valve replacement.
- Changes in valvular anatomy and functional orifice size were assessed through visual inspection and geometric measurements.
Main Results:
- Balloon valvuloplasty had no detectable impact on valvular anatomy in 19 out of 30 patients.
- Only 11 patients experienced minimal or moderate enlargement of the functional aortic orifice.
- No patient demonstrated a substantial increase in functional orifice size post-procedure.
Conclusions:
- The benefits of balloon valvuloplasty for calcified aortic stenosis appear overstated.
- This procedure should be reserved for patients with prohibitive surgical risks.
Abstract:
Balloon dilation by the percutaneous route has recently been recommended as an alternative to surgical intervention in the management of calcified aortic valvular stenosis. To investigate the validity of balloon valvuloplasty, this procedure was carried out in the operating room under direct vision in 30 patients just prior to excision and replacement of the ossified aortic valve. Changes induced by balloon dilation were evaluated by visual inspection as well as by geometric measurements. By visual observation, balloon valvuloplasty did not have a detectable impact on the valvular anatomy in about 19 of the patients and induced enlargement of the functional aortic orifice judged as "minimal" or "moderate" in only 11. In no patient was there a substantial increase in the functional orifice size. These findings were supported by geometrical measurements. Therefore, we believe that the virtues of this procedure have been grossly overstated by its proponents and that it should be offered only to patients who present a truly forbidding risk by standards of modern surgery.