European Journal of Cardio-Thoracic Surgery, Vol 10, 977-982, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Aortic valve replacement after aortic valvuloplasty for calcified aortic stenosis
R Soyer, F Bouchart, JP Bessou, M Redonnet, D Mouton-Schleifer, G Derumeaux, J Arrignon and B Letac
Department of Thoracic and Cardiovascular Surgery, Charles Nicolle Hospital, Rouen, France.
OBJECTIVE: This study concerns patients who underwent one or several aortic
balloon valvuloplasties at our institution and subsequently required
cardiac surgery, either on an emergency basis after aortic valvuloplasty or
due to the development of aortic stenosis. METHODS: Between February 1987
and December 1993, 137 patients (73 male, 64 female, mean age 72 +/- 9
years) underwent aortic valve replacement for calcified aortic stenosis
after several percutaneous balloon aortic valvuloplasties. Thirty-one
patients were in NYHA stage II, 70 in stage III and 36 in stage IV. Seventy
patients had angina (23 stage I or II, 47 stage III or IV) and 24 patients
presented syncope or lipothymia. Twenty-three percent had at least two of
these three symptoms. The indications for balloon dilatation were
non-definitive surgical contraindication or high surgical risk (73),
personal choice (49), refusal of surgery (9) and emergency (5:2 massive
aortic regurgitation, 1 left ventricle perforation, 1 cardiogenic shock, 1
endocarditis in cardiogenic shock). Seven patients received preoperative
aortic valvuloplasty due to a very high operative risk. The average time
between dilatation and surgery was 472 days and there was clinical
improvement for an average period of 261 days. The aortic valve
replacements consisted of 58 mechanical prostheses and 79 xenografts with
22 concomitant procedures. RESULTS: Operative mortality was eight patients
(5.8%). During the follow-up (17.4 +/- 9.2 months), four patients died
(3.6%), 91.2% of the patients were in class I and II and 95% were without
angina. The actuarial survival rate was 90.5 +/- 6.6% including hospital
mortality. CONCLUSIONS: Both our experience and the literature show that
balloon aortic valvuloplasty is followed by an immediate improvement in
hemodynamic status with a decrease in valve gradient and an increase in
valve area. However, the hemodynamic benefit is typically short-lived with
a very high restenosis rate. Balloon aortic valvuloplasty is not an
alternative to aortic valve replacement, which remains the best treatment
for calcified aortic stenosis; the benefits and long-term results of aortic
valve replacement are well established, even in the elderly.
