Balloon aortic valvuloplasty in the elderly: useful when there is no alternative
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E Di Segni1, O Agranat, Y H Zahav
1Heart Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Insights
Balloon aortic valvuloplasty offers symptomatic improvement for elderly patients with severe aortic stenosis who are high surgical risks. This minimally invasive procedure shows promising short-term survival benefits compared to no intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Calcific aortic stenosis is a significant cause of morbidity and mortality in the elderly.
- Many elderly patients with severe aortic stenosis are poor surgical candidates, necessitating alternative treatments.
- Balloon aortic valvuloplasty (BAV) has emerged as a less invasive option.
Purpose of the Study:
- To evaluate the safety and efficacy of a new technique for balloon aortic valvuloplasty (BAV) in elderly patients with severe calcific aortic stenosis.
- To assess the impact of BAV on hemodynamic parameters, symptoms, and survival rates.
- To compare outcomes in BAV patients with a matched control group who refused the procedure.
Main Methods:
- A cohort of 26 elderly patients with severe calcific aortic stenosis underwent BAV using the Cribier and Letac technique.
- Patients were selected due to high surgical risk or ineligibility for surgery.
- A control group of 7 matched patients who declined BAV was used for comparison.
Main Results:
- BAV significantly reduced the aortic gradient (78 to 35 mm Hg) and increased aortic valve area (0.47 to 0.83 cm2; P < 0.0001).
- Immediate symptomatic improvement was observed in all patients.
- Short-term survival was higher in the BAV group (87% at 3 months) compared to the control group (57% at 3 months).
- Complications were infrequent, with one case of femoral artery occlusion requiring repair.
Conclusions:
- Balloon aortic valvuloplasty is a safe and effective treatment for elderly patients with severe calcific aortic stenosis who are not surgical candidates.
- The procedure leads to significant hemodynamic improvement and symptomatic relief.
- BAV may improve short-term survival in this high-risk patient population.
Abstract:
Of 63 elderly patients with calcific aortic stenosis in whom balloon aortic valvuloplasty was performed, 26 treated with the new technique of Cribier and Letac are the subject of this report. Patients were referred for the procedure because they were at high surgical risk, or were not candidates for surgery. Seven matched patients who fit the criteria for balloon valvuloplasty but refused the valvuloplasty procedure served as controls. Aortic gradient decreased from 78 +/- 27 mm Hg to 35 +/- 20 mm Hg and aortic valve area increased from 0.47 +/- 0.16 cm2 to 0.83 +/- 0.38 cm2 (P < 0.0001). Symptomatic improvement was immediately obtained in each patient. Complications were rare, with only one patient needing vascular repair for femoral artery occlusion. Three patients died during the initial hospitalization (none during the procedure). Valvuloplasty patients were followed for a mean period of 9.6 +/- 9.4 months. Three months survival was 87%, 6 months survival was 76%, and 12 months survival was 61%. Four of seven patients in the control group (57%) died within 3 months after initial referral. Balloon aortic valvuloplasty is a useful treatment in elderly patients who are poor surgical candidates. It may have a positive influence on short-term survival.