[Aortic valve stenosis in the aged--replacement or dilatation?]

In patients with severe symptomatic aortic stenosis the prognosis is very poor (1 year mortality rate 54%). Percutaneous transluminal aortic valvuloplasty shows a primary success rate of 86% and an in hospital mortality rate of 7%. However, within 6 to 12 months in almost all patients restenosis occurred. 23% of the patients died within this time range. 13 subjects with restenosis underwent redilatation or valve surgery. Aortic valve surgery is the treatment of choice in this setting. The method demonstrates also in elderly patients a relatively low early mortality rate and excellent long term results. Patients in NYHA stage IV, with severe coronary heart disease and with impaired left ventricular function (LVEF < 50%) show a 2.5 to 3.6 times increased early postoperative mortality rate. In these patients valvuloplasty may be performed as a palliative therapy or as a bridging procedure to aortic surgery. Aortic valvuloplasty may be indicated further in patients with reduced general conditions or severe secondary diseases.