October 1, 1988Circulation
Doppler evaluation of results of percutaneous aortic balloon valvuloplasty in calcific aortic stenosis.
Key result
Percutaneous aortic balloon valvuloplasty acutely lowers mean gradient, but restenosis recurs by ~6 months.
- P<0.0001
- n=55
Why the study?
The short-term results and clinical outcomes of percutaneous aortic balloon valvuloplasty in elderly high-risk patients with severe calcific aortic stenosis were evaluated.
Does percutaneous aortic balloon valvuloplasty improve echocardiographic and clinical outcomes in elderly patients with symptomatic, severe aortic stenosis at high surgical risk?
Population
55 consecutive elderly patients with symptomatic severe aortic stenosis at high surgical risk
Comparison
Percutaneous aortic balloon valvuloplasty with no comparator
Design
Observational case series
Follow-up
Mean 6.2 months
Authors
Discussion
Loading...
Member takes
Implication
High short-term mortality and reinterventions after balloon valvuloplasty in high-risk elderly patients; leaves open its comparative role versus surgery in prospective trials.
Key Points
- To evaluate the short-term clinical outcomes and hemodynamic durability of percutaneous aortic balloon valvuloplasty in high-risk elderly patients with severe calcific aortic stenosis.
- Followed 55 consecutive elderly patients with symptomatic, severe aortic stenosis at high surgical risk undergoing percutaneous aortic balloon valvuloplasty.
- Assessed outcomes over a mean follow-up of 6.2 months using serial clinical examinations and Doppler echocardiography.
- Aortic valve mean gradient decreased from 48 +/- 18 to 33 +/- 12 mm Hg immediately post-procedure (p < 0.0001) but rebounded to 46 +/- 16 mm Hg at follow-up (p < 0.05).
- Aortic valve area increased from 0.54 +/- 0.15 to 0.85 +/- 0.23 cm2 initially (p < 0.0001) but significantly decreased to 0.67 +/- 0.19 cm2 at follow-up (p < 0.05).
- Overall mortality included 3 early (<30 days) and 8 late deaths; 9 patients required subsequent surgery and 4 had repeat valvuloplasty, though severe symptoms dropped from 76% to 38% in 30-day survivors.
Study Design
Type
Observational (n=55)
Structured PICO
Does percutaneous aortic balloon valvuloplasty improve echocardiographic and clinical outcomes in elderly patients with symptomatic, severe aortic stenosis at high surgical risk?
P
Population
55 elderly patients with symptomatic, severe aortic stenosis at high surgical risk, followed for a mean of 6.2 months.
E
Exposure
Percutaneous aortic balloon valvuloplasty
O
Outcome
Short-term results evaluated by clinical evaluation and Doppler echocardiography (including aortic valve mean gradient, aortic valve area, and mortality)surrogate
Main Result
p-value: p=<0.0001
Percutaneous aortic balloon valvuloplasty in high-risk elderly patients with severe aortic stenosis provides initial hemodynamic improvement that is frequently lost at short-term follow-up due to restenosis, though a subset experiences sustained clinical benefit.
Cite This Study
Nishimura et al. (1988) conducted an observational in calcific aortic stenosis (n=55). Percutaneous aortic balloon valvuloplasty was evaluated on Aortic valve mean gradient (p=<0.0001). Percutaneous aortic balloon valvuloplasty initially reduced aortic valve mean gradient (48 to 33 mm Hg, p<0.0001), but restenosis occurred at 6.2 months with gradient returning to 46 mm Hg (p<0.05).