Percutaneous Balloon Aortic Valvuloplasty: The State of the Art. A Review of Two Years Experience in Rouen

From the Service de Cardiologie, Centre Hôspitaller el Universitaire, Hopital Charles Nicolle, Rouen, France
Journal of Interventional Cardiology (Impact Factor: 1.18). 06/2007; 1(4):237 - 250. DOI: 10.1111/j.1540-8183.1988.tb00943.x


Since the first case performed by us in September 1985, percutaneous transluminal aortic valvuloplasty (PTAV) has been applied in Rouen in a broad clinical spectrum of patients with aortic stenosis. After our encouraging initial experience, there have been changes in our objectives and technique which have allowed us to proceed more quickly, with less discomfort to the patient, lower risk, and improved results. The development of a new device, a triple lumen-double size balloon catheter has been a major advance as well as the use of extra-stiff guidewires and arterial sheaths.
Our series has grown to more than 300 patients, mostly elderly (mean age 73 ± 11, 25% at or above 80) and very ill (71% in NYHA functional class HI or IV). Indication for PTA V was either absolute contraindication to valve replacement (30%), increased surgical risk (31%), refusal of surgery (10%), or attempt to postpone surgery (29%).
The largest balloon size used has been 20 mm or above (23 mm or even 25 mm) in 70% of the cases. The double-balloon technique has been used in only 5% of the cases. In our series, PTAV resulted in a decrease in transvalvular peak gradient from 71 ± 26 mm Hg to 28 ± 13 mm Hg and an increase in aortic valve area from 0.54 ± 0.18 cm2 to 0.96 ± 0.33 cm2. With gained experience and the use of larger balloon sizes, the results have clearly improved: in the last 100 patients a valve area to or above 1 an2 has been obtained in 55% compared to 30% of the cases in our early experience. Patients less than 70 years old had the best results but the aortic stenosis was less severe before PTAV.
The total procedural and post-PTA V mortality was 4% and involved primarily very old patients. The nonfatal complication rate remained low. Clinical information for 204 patients followed for 12 ± 5 months has been obtained and repeat catheterization has been done in 56 patients at an average of 4.5 months after PTA V.
The data confirms that PTA V is feasible and can be accomplished with a relatively low risk in an elderly and ill population and in patients with contraindication to valve replacement or very high surgical risk. The procedure alters the natural history of the disease in these patients, improving both symptoms and survival. Indications in other categories of patients deserve further studies.

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