Balloon aortic valvuloplasty revisited: The role of the Inoue balloon and transseptal antegrade approach

Percutaneous aortic balloon valvuloplasty (PABV) was developed to provide a less invasive alternative to aortic valve replacement. Despite initially f avorable results, PABV has not produced reliable and durable outcomes. The Inoue balloon used for PABV via an antegrade transseptal approach may offer an improvement over the Mansfield balloons via the identical route. Thirte en consecutive patients with severe symptomatic aortic stenosis were referr ed for percutaneous aortic balloon valvuloplasty. All patients were conside red unacceptably high-risk surgical candidates. Seven consecutive patients underwent antegrade transseptal PABV with Mansfield balloons and in the fol lowing six the Inoue balloon was used. The study group was characterized by advanced age (mean, 77) and multiple comorbid conditions (mean, 2.5/patien t). Before PABV, the two groups did not differ with respect to age, mean NY HA class, LVEF, transaortic gradient, cardiac output, or aortic valve area. All patients had initial hemodynamic improvement. Complications included o ne stroke and one vascular injury. After valvuloplasty, cardiac output was not significantly changed. However, there was a significant decrease in aor tic gradient and an increase in aortic valve area in both groups; the incre ase in aortic valve area was significantly greater in those treated with th e Inoue balloon (P = 0.039), Total follow-up mortality was high but appeare d to be delayed in the Inoue group. The use of the Inoue balloon with an an tegrade transseptal approach warrants further investigation as a preferred technique for PABV. Cathet Cardiovasc. Intervent 50:484-491, 2000. (C) 2000 Wiley-Liss, Inc.