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Editorials

Will the use of percutaneous aortic valves remain compassionate?

Carolinas Medical Center, 1001 Blythe Boulevard, Suite 300, Charlotte, NC 28203, United States

^_* Corresponding author. Tel.: +1 704 444 3911; fax: +1 704 373 0781. (Email: francis.robicsek@carolinashealthcare.org).

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The mid 1990s saw the emergence of percutaneous dilatation of the calcified aortic valve (also known as aortic balloon valvuloplasty). The procedure was initially touted [1] as a gentle and minimally invasive approach that will eventually replace surgery. However, it soon became evident that in contrast to mitral balloon dilatation, the benefits of ballooning the calcified aortic valve were minimal if any and short-lasting [2]. For these reasons it was recommended that the procedure should be applied only on a compassionate basis, i.e. in patients who had unacceptably high risk for a surgical intervention. Unfortunately, this pretense was more often than not disregarded and ossified aortic valves were dilated by the thousands, including those in patients having well acceptable surgical risks. Only after several years when the overwhelming number of short-term failures became undeniable did the technique fall in disrepute, and nowadays it is utilized only as a last resort for short-term palliation. It is notable, however, that whenever the procedure acutely failed and there was a need for immediate surgical intervention, most of these inoperable patients came through surgery unscathed. Also, nobody expressed any remorse or accepted responsibility for the aortic balloon valvuloplasty fiasco.

Now, we . . . [Full Text of this Article]