What can be expected of balloon aortic valvuloplasty in adults?

Introduced more than 15 years ago, balloon aortic valvuloplasty (BAV) has c learly delineated indications and limitations. Although, aortic valve repla cement is undoubtedly the treatment of choice for healthy patients with aor tic stenosis, BAV has been demonstrated as a valuable and safe palliative p rocedure for patients considered too risky or old for current day surgery. Between January 1991 and December 1999, 558 patients (mean age 76 +/- 11 ye ars, 479 [57%] women) underwent BAV at our center. Indications for BAV were contraindication to surgery in 16.2% of the patients, high risk in 40.4%, refusal of surgery in 10.7%, personal decision in 28.5%, and other in 14.2% . The mean gradient decreased from 65 +/- 23 to 27 +/- 12 mmHg and the valv e area increased from 0.56 +/- 0.19 cm(2) to 1.0 +/- 0.38 cm(2). Eleven (1. 1%) patients died during the procedure. The other severe complications were complete AV block in 18 (1.8%) patients, stroke in 8 (0.8%), tamponade in 6 (0.6%), and massive aortic insufficiency in 4 (0.4%). In conclusion, BAV does not replace valve replacement, even in the elderly. All those who can be operated on, should be. However; if surgical intervention is not conside red reasonable, BAV offers good immediate results with an acceptable compli cation rate. Furthermore, previous published series have demonstrated that BAV is particularly indicated in specific subgroups, such as very old patie nts with high operative risk, end-stage heart failure, cardiogenic shock, o r general anesthesia for noncardiac surgery.