Staged Balloon Aortic Valvuloplasty before Standard Aortic Valve Replacement in Selected Patients with Severe Aortic Valve Stenosis

被引:2
作者
Altarabsheh, Salah Eldien [1 ]
Greason, Kevin L. [1 ]
Schaff, Hartzell V. [1 ]
Suri, Rakesh M. [1 ]
Li, Zhuo [2 ]
Mathew, Verghese [3 ]
Joyce, Lyle D. [1 ]
Park, Soon J. [1 ]
Dearani, Joseph A. [1 ]
机构
[1] Mayo Clin, Div Cardiovasc Surg, Rochester, MN 55905 USA
[2] Mayo Clin, Div Biomed Stat & Informat, Rochester, MN 55905 USA
[3] Mayo Clin, Div Cardiovasc Dis, Rochester, MN 55905 USA
关键词
Algorithms; aortic valve stenosis/surgery/therapy; balloon valvuloplasty; aortic; calcinosis/therapy; heart valve prosthesis implantation/mortality; retrospective studies; treatment outcome; HIGH-RISK PATIENTS; TRANSCATHETER; IMPLANTATION; OUTCOMES; SURGERY; ERA; BRIDGE;
D O I
10.14503/THIJ-13-3298
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
This study evaluated preoperative balloon aortic valvuloplasty (BAV) as a technique to decrease aortic valve replacement (AVR) risk in patients who have severe symptomatic aortic valve stenosis with substantial comorbidity. We report the outcomes of 18 high-risk patients who received BAV within 180 days before AVR from November 1993 through December 2011. Their median age was 78 years (range, 51-93 yr), and there were 11 men (61%). The pre-BAV median calculated Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) was 18.3% (range, 9.4%-50.7%). Preoperative left ventricular ejection fraction measured a median of 0.23 (range, 0.05-0.68), and the median aortic valve area index was 0.4 cm(2)/m(2) (range, 0.2-0.7 cm(2)/m(2)). The median interval from BAV to AVR was 28 days (range, 1-155 d). There were no strokes or deaths after BAV; however, 4 patients (22%) required mechanical circulatory support, 3 (17%) required femoral artery operation, and 1 (6%) developed severe aortic valve regurgitation. After BAV, the median STS PROM fell to 9.1% (range, 2.6%-25.7%) (compared with pre-BAV, P <0.001). Echocardiography before AVR showed that the median left ventricular ejection fraction had improved to 0.35 (range, 0.15-0.66), and the aortic valve area index to 0.5 cm(2)/m(2) (range, 0.3-0.7 cm(2)/m(2)) (compared with pre-BAV, both P < 0.05). All patients received AVR. Operative death occurred in 2 patients (11%), and combined operative death and morbidity in 7 patients (39%). Staged BAV substantially reduces the operative risk associated with AVR in selected patients.
引用
收藏
页码:152 / 158
页数:7
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