LONG-TERM FOLLOW-UP-STUDY ON 64 ELDERLY PATIENTS AFTER BALLOON AORTICVALVULOPLASTY

Background and aims of the study: The aims of this study were to evalu ate symptomatic improvement and event-free/overall survival after ball oon aortic valvulotomy in patients with significant sclerotic aortic v alve stenosis. Methods: Sixty-four patients with calcified aortic sten osis, in NYHA class III-IV, and of mean age 79.0 years, underwent a to tal of 75 scheduled attempts at balloon aortic valvulotomy, with singl e balloon catheters between December 1987 and June 1993. Patients were either considered as poor surgical candidates or themselves preferred such valvulotomy. Results: Periprocedural major complications, includ ing death in 6%, occurred in association with 16% of the procedures. A mong 57 patients ist whom initial dilatation was successful, the avera ge period of symptom relief was 9.4 months (median 7.0, range: 0 to 47 months). Independent predictors for longer duration of symptom relief and survival were systolic arterial pressure >115 mmHg and female gen der; ejection fraction greater than or equal to 30% was only predictiv e of survival. Actuarial survival rates at one, two and three years we re 77, 48 and 36% respectively, Conclusions: Balloon aortic valvulotom y is followed by a short period of symptomatic relief and carries a lo w periprocedural mortality, but considerable morbidity. By comparison, aortic valve replacement patients aged over 70 and with serious physi cal limitations (NYHA class IIIB-IV) showed much better overall surviv al. As contraindications to surgery are in most cases relative, aortic valve replacement should always be considered as the only choice in t he surgical decision-making.