Revival of an old method with new techniques: balloon aortic valvuloplasty of the calcified aortic stenosis in the elderly

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• 作者：Stefan Sack (1)
  Philipp Kahlert (1)
  Sasan Khandanpour (1)
  Christoph Naber (1)
  Sebastian Philipp (1)
  Stefan M?hlenkamp (1)
  Burkhard Sievers (1)
  Hagen K?lsch (1)
  Raimund Erbel (1)
  
• 关键词：aortic stenosis ; balloon aortic valvuloplasty ; burst pacing ; elderly
• 刊名：Clinical Research in Cardiology
• 出版年：2008
• 出版时间：May 2008
• 年：2008
• 卷：97
• 期：5
• 页码：288-297
• 全文大小：337KB
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• 作者单位：Stefan Sack (1)
  Philipp Kahlert (1)
  Sasan Khandanpour (1)
  Christoph Naber (1)
  Sebastian Philipp (1)
  Stefan M?hlenkamp (1)
  Burkhard Sievers (1)
  Hagen K?lsch (1)
  Raimund Erbel (1)
  
  1. Klinik für Kardiologie, Westdeutsches Herzzentrum Essen, Zentrum für Innere Medizin, Universit?tsklinikum Essen, Hufelandstrasse 55, 45122, Essen, Germany
  

文摘

Balloon aortic valvuloplasty (BAV), introduced since almost 20 years, has experienced a revival for its use in the treatment of elderly patients with severe calcified aortic stenosis that are associated with high operative risk and co-morbidities. This is due to the introduction of new balloon catheters and techniques. This study reports about 75 such cases performed within the past 28 months. The mean age of our patient group was 78 ± 7 years (median = 80 years). Risk calculation with the EuroSCORE demonstrated an average value of 24.4 ± 19.5%. BAV was performed along with burst pacing to reduce transvalvular blood flow for stabilization of the balloon catheter until blood pressure dropped to less than 50 mmHg. BAV was performed in 72 patients with a procedural success rate of 73%. There was a decrease of 31 mmHg peak-to-peak gradient across the aortic valve from 63 ± 35 to 32 ± 22 mmHg (P < 0.0001). Mean gradient was reduced from 51 ± 24 to 27 ± 15 mmHg (P < 0.0001). Aortic valve area increased by 49% from 0.84 ± 0.33 to 1.25 ± 0.45 cm2 (P < 0.0001). Serious adverse events (SAE) occurred in 17% of the 75 BAV procedures. Follow-up revealed a significant improvement in 6-month and 1-year survival. The improved technology of BAV makes this technique attractive for elderly patients who are at high operative risk or in cases where valve replacement was refused for any reason.