AORTIC-VALVE REPLACEMENT AFTER PERCUTANEO US AORTIC VALVULOPLASTY FORCALCIFIED AORTIC-STENOSIS - A SERIES OF 104 PATIENTS

Between February 1987 and December 1990, 104 patients (48 men, 56 wome n) with an average age of 69 years, underwent aortic valve replacement (AVR) after one or several percutaneous aortic valve balloon dilatati on. Thirty one patients were in Class II and 73 patients in Classes II I and IV. Twenty two patients had angina (16 Class I-II, 6 Class III-I V) and 12 patients had syncope or near syncope on effort. The indicati ons of valvuloplasty were: non-definitive contraindications of surgery or a surgical risk which was estimated to be excessive (46 patients), a personal choice (41 patients). Five patients underwent preoperative di latation because of the high operative risk; 7 patients refused su rgery and 5 patients were operated as an emergency (2 mas-sive aortic regurgitations, 1 left ventricular perforation, 1 cardiogenic shock, 1 endocarditis with cardiogenic shock). The inter-val bet ween dilatati on and surgery was on average 472 days. The patients were improved ove r an average period of 261 days. Apart form the emergency cases, the p atients were operated because of restenosis. Surgery consisted of 53 m echanical and 51 bioprosthetic valve replacements. There was an associ ated procedure in 17 cases (17 single bypass grafts, 2 double bypass, 1 triple bypass graft, 1 left ventricular suture, 1 Bigelow procedure, 2 mitral valve replacements, 1 tricuspid annuloplasty, 1 carotid enda rteriectomy, 1 replacement of the ascending aorta, 1 closure of ASD). The operative mortality was 7 patients (6.7 %). The operative findings were 8 lesions related to dilatation, mainly valve tears or disinsert ions requiring rapid (6 cases) or emergency (2 cases) surgery for mass ive aortic regurgitation. There were no signs of dilatation of the aor tic orifice or increase in valve mobility in the other patients. The p atients were divided into 2 subgroups: patients with a high surgical r isk and those with a low ejection fraction. The authors'experience and reported data indicate that balloon aortic valvuloplasty should not b e considered an alternative to aortic valve replacement. Its only rati onale is surgical contraindications and eventually as preparation for surgery in cases with a precarious haemodynamic status providing they are operated as rapidly as possible after valvuloplasty.