COMPARISON OF AORTIC-VALVE REPLACEMENT AND PERCUTANEOUS AORTIC BALLOON VALVULOPLASTY FOR ELDERLY PATIENTS WITH AORTIC-STENOSIS

The outcome of aortic balloon valvuloplasty (ABV) was compared with th at of aortic valve replacement (AVR) in aortic stenosis (AS) patients more than 60 years old. The indications for ABV included low respirato ry and renal function, cancer, the patient's refusal of surgery, and l ow daily activity. Twenty six patients underwent AVR and 13 underwent ABV. Initially, the AVR group was younger and more symptomatic than th e ABV group. Two perioperative deaths occurred in the AVR group, while there were none in the ABV group. Twenty-four AVR patients and 12 ABV patients had a successful outcome, with remarkable pressure gradient reduction in both groups. In the follow-up, only 1 death and no cardia c events were detected in the AVR group (mean follow-up of 27 months), whereas 3 deaths, 6 heart failures, 2 repeated ABV, and 4 AVR were se en in the ABV group (mean follow-up of 10 months). The data showed tha t ABV was safer than AVR, but a higher rate of restenosis limited its efficacy. In the ABV group, a higher ratio of balloon size to aortic d iameter correlated with longer event-free survival. We concluded that for elderly AS patients, ABV should be used only in those with high su rgical risk as a palliative therapy or a bridge therapy to AVR, and AV R should be primarily recommended under rigid evaluation of the patien t's physical status.