Aortic balloon valvuloplasty and aortic valve replacement: A comparative follow-up study

Abstract

The purpose of this study was to compare the short-term and long-term benefits and complications of patients subjected to aortic balloon valvuloplasty with those of a similar group of patients subjected to aortic valve replacement. Both groups were matched for age and sex and followed up to December 1991. The study period for the valvuloplasty group was from 1986 to 1991. The surgical group was studied from 1979 to 1991. Clinical and hemodynamic data were collected prospectively. Short- and long-term follow-ups were collected retrospectively from chart reviews, telephone inquiries with patients, immediate relatives, and family physicians. A total of 66 patients were studied; 33 had balloon valvuloplasty. A similar number of surgical patients were randomly selected from a group of 60 who had aortic valve replacement, to match the age and sex of the valvuloplasty group. Baseline, clinical, and hemodynamic characteristics were similar in both groups. All patients had right, retrograde, and transseptal left heart catheterization. Gradient across aortic valve was measured by simultaneous recording of pressures in left ventricle and aorta. Indicator dilution curves were used to calculate cardiac index and assess severity of aortic regurgitation. Patients with regurgitant fraction >25% were excluded from aortic valvuloplasty. Although inhospital mortality was higher in surgically treated patients (12% vs 9%) the 5-year survival of valve replacement was much better than those treated with balloon valvuloplasty (71% vs 7%). Our selection of patients and immediate results of valvuloplasty are comparable to seven published series. Aortic balloon valvuloplasty should not be used as a routine or elective procedure for treatment of adult patients with aortic stenosis. It could, however, be considered as a “bridge” procedure to stabilize high-risk patients before surgical replacement of the valve.