Ab. Buchwald et al., Efficacy of balloon valvuloplasty in patients with critical aortic stenosis and cardiogenic shock - The role of shock duration, CLIN CARD, 24(3), 2001, pp. 214-218
Background: Because of limited long-term success, aortic balloon valvulopla
sty is considered to be a palliative procedure, including patients at exces
sive risk for standard thera py-aortic valve replacement-that is, those in
cardiogenic shock.
Hypothesis: The study was undertaken to evaluate the outcome of balloon val
vuloplasty for critical aortic stenosis complicated by cardiogenic shock.
Methods: Over a 10-year-period, we followed 14 patients (age 74 +/- 11 year
s, range 50-91) presenting in cardiogenic shock and critical aortic stenosi
s, who underwent valvuloplasty, together with 19 patients with critical aor
tic stenosis requiring urgent major noncardiac surgery.
Results: In patients in shock, calculated aortic valve area could be increa
sed successfully by at least 0.3 cm(2), from 0.38 +/- 0.09 to 0.81 +/- 0.12
cm(2), with an insignificant increase in cardiac index from 1.89 +/- 0.33
to 2.01 +/- 0.411/min*m(2). In-hospital mortality was 71% (10 patients). Tw
o patients underwent valve replacement within 16 days and survived after 1
year, as did two patients refusing surgery By multivariate logistic regress
ion analysis, only an interval between onset of shock symptoms and valvulop
lasty of >48 h was significantly associated with fatal outcome (p < 0.01).
In those patients requiring noncardiac surgery, this was possible after val
vuloplasty in 95% who survived 1 year after hospital discharge. One patient
in this group died of pulmonary embolism the day after the procedure.
Conclusion: These data support the concept of causal treatment in patients
with cardiogenic shock, as well as in the set-ting of cardiogenic shock and
critical aortic stenosis, at the earliest possible convenience.