Aortic valvuloplasty for acquired aortic stenosis.

Area of Science:

• Cardiology
• Cardiac Surgery
• Interventional Cardiology

Background:

• Prosthetic valves have reduced adult aortic valvuloplasty rates.
• Aortic valvuloplasty remains primary for congenital aortic stenosis.
• Long-term success in acquired aortic stenosis requires valve area > 1.0 cm² and minimal insufficiency.

Purpose of the Study:

• To evaluate the efficacy of aortic valvuloplasty in adult patients with contraindications to anticoagulation.
• To assess outcomes in patients with small aortic roots undergoing aortic valvuloplasty.

Main Methods:

• Twenty-three adult patients (mean age 75) with small aortic roots and anticoagulation contraindications underwent aortic valvuloplasty.
• Two-dimensional contrast echocardiography assessed leaflet mobility and aortic insufficiency.
• Cardiac outputs and pressure gradients were measured to calculate valve area before and after the procedure.

Main Results:

• Postrepair mean gradient decreased from 54 ± 6.3 mm Hg to 9 ± 1.4 mm Hg (p=0).
• Postrepair mean valve area increased significantly from 0.55 ± 0.05 cm² to 1.56 ± 0.05 cm² (p=0).
• Two patients required reoperation: one for endocarditis, one for restenosis (valve area only increased to 0.91 cm²).

Conclusions:

• Aortic valvuloplasty can effectively improve hemodynamics in select adult patients.
• Achieving a valve area greater than 1.0 cm² is crucial for long-term success.
• Careful patient selection is necessary to minimize complications like restenosis and endocarditis.