Key result
Balloon valvuloplasty in elderly patients with severe aortic stenosis may serve as a bridge to surgery, but has a roughly 5% major periprocedural complication rate and high 6-month restenosis.
Why the study?
Is there any indication for balloon aortic valvuloplasty in elderly patients with severe symptomatic calcific aortic stenosis?
Is there any indication for balloon aortic valvuloplasty in elderly patients with severe symptomatic calcific aortic stenosis?
Balloon valvuloplasty in the elderly with severe aortic stenosis is primarily indicated as a bridge to surgery or for palliative symptom relief in non-surgical candidates, given its high restenosis rate and lack of mortality benefit.
Cautions against routine use in elderly severe AS; leaves open palliative role pending higher-level evidence.
Elderly patients with severe symptomatic calcific aortic stenosis do poorly with medical management. The optimal treatment for this group of patients is surgical valve replacement. Balloon valvuloplasty may be useful as a bridge to aortic valve replacement in hemodynamically unstable patients, in patients undergoing emergent noncardiac surgery, and in patients with severe comorbidities who are too ill to undergo cardiac surgery. Balloon valvuloplasty often results in symptomatic improvement; however, the postvalvuloplasty valve area is usually <1.0 cm2, the major periprocedural complication rate is roughly 5%, and the 6-month restenosis rate is quite high. There is no evidence that balloon valvuloplasty alters the natural history of aortic stenosis, although no randomized study has been performed.
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Dauterman et al. (2003) conducted a review in Severe symptomatic calcific aortic stenosis. Balloon valvuloplasty vs. Surgical valve replacement was evaluated. Balloon valvuloplasty in elderly patients with severe aortic stenosis may serve as a bridge to surgery, but has a roughly 5% major periprocedural complication rate and high 6-month restenosis.
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