Percutaneous Balloon Valvuloplasty for Critical Aortic Stenosis: A Bridge to Safer Noncardiac Surgical Procedures

Abstract

In this issue of the Proceedings (pages 753 to 757), Hayes and associates describe their experience with use of percutaneous aortic balloon valvuloplasty to decrease the risk of noncardiac surgical and invasive diagnostic procedures in 15 elderly patients (mean age, 79 years) who had critical aortic stenosis. All 15 patients had dyspnea on exertion, 8 had symptoms of angina, and 3 had syncope. The noncardiac condi­ tions for which surgical treatment was needed were hip fractures, known cancers, undiagnosed lung masses, and active gastrointestinal or urinary tract bleeding. Of the 15 patients, 7 were thought not to be candidates for aortic valve replacement because of active bleeding or other medical contraindications. The other eight patients were not candidates because of known or suspected metastatic cancer. Balloon valvuloplasty, performed with use of ei­ ther single or double balloons and standard val­ vuloplasty techniques, resulted in hemodynamic im­ provement. The results were comparable to those previously reported for aortic valvuloplasty. The mean aortic gradient decreased from 58 to 32 mm Hg, and the aortic valve area increased from 0.49 to 0.85 cm 2 . The cardiac index was unchanged. Of the 15 patients, 5 had major complications related to the aortic valvuloplasty. One patient died after left ventricular perforation. In two other pa­ tients, left ventricular perforation was successfully treated by pericardiocentesis. One patient required surgical repair of bilateral femoral pseudoaneurysms, and one patient had left bundle-branch block and transient congestive heart failure. The noncardiac surgical and invasive diagnostic procedures that were performed included total hip