AORTIC-VALVE REPLACEMENT AFTER AORTIC VALVULOPLASTY FOR CALCIFIED AORTIC-STENOSIS

Objectives. This study concerns patients who underwent one or several aortic balloon valvuloplasties at our institution and subsequently req uired cardiac surgery, either on an emergency basis after aortic valvu loplasty or due to the development of aortic stenosis. Methods. Betwee n February 1987 and December 1993, 137 patients (73 male, 64 female, m ean age 72+/-9 years) underwent aortic valve replacement for calcified aortic stenosis after several percutaneous balloon aortic valvuloplas ties. Thirty-one patients were in NYHA stage II, 70 in stage III and 3 6 in stage IV. Seventy patients had angina (23 stage I or II, 47 stage III or IV) and 24 patients presented syncope or lipothymia. Twenty-th ree percent had at least two of these three symptoms. The indications for balloon dilatation were non-definitive surgical contraindication o r high surgical risk (73), personal choice (49), refusal of surgery (9 ) and emergency (5: 2 massive aortic regurgitation, 1 left ventricle p erforation, 1 cardiogenic shock, 1 endocarditis in cardiogenic shock). Seven patients received preoperative aortic valvuloplasty due to a ve ry high operative risk. The average time between dilatation and surger y was 472 days and there was clinical improvement for an average perio d of 261 days. The aortic valve replacements consisted of 58 mechanica l prostheses and 79 xenografts with 22 concomitant procedures. Results . Operative mortality was eight patients (5.8%). During the follow-up (17.4+/-9.2 months), four patients died (3.6%), 91.2% of the patients were in class I and II and 95% were without angina. The actuarial surv ival rate was 90.5+/-6.6% including hospital mortality. Conclusions. B oth our experience and the literature show that balloon aortic valvulo plasty is followed by an immediate improvement in hemodynamic status w ith a decrease in valve gradient and an increase in valve area. Howeve r, the hemodynamic benefit is typically short-lived with a very high r estenosis rate. Balloon aortic valvuloplasty is not an alternative to aortic valve replacement, which remains the best treatment for calcifi ed aortic stenosis; the benefits and long-term results of aortic valve replacement are well established, even in the elderly.