Abstract
The purpose of this study was to compare the short-term and long-term benefits and
complications of patients subjected to aortic balloon valvuloplasty with those of
a similar group of patients subjected to aortic valve replacement. Both groups were
matched for age and sex and followed up to December 1991. The study period for the
valvuloplasty group was from 1986 to 1991. The surgical group was studied from 1979
to 1991. Clinical and hemodynamic data were collected prospectively. Short- and long-term
follow-ups were collected retrospectively from chart reviews, telephone inquiries
with patients, immediate relatives, and family physicians. A total of 66 patients
were studied; 33 had balloon valvuloplasty. A similar number of surgical patients
were randomly selected from a group of 60 who had aortic valve replacement, to match
the age and sex of the valvuloplasty group. Baseline, clinical, and hemodynamic characteristics
were similar in both groups. All patients had right, retrograde, and transseptal left
heart catheterization. Gradient across aortic valve was measured by simultaneous recording
of pressures in left ventricle and aorta. Indicator dilution curves were used to calculate
cardiac index and assess severity of aortic regurgitation. Patients with regurgitant
fraction >25% were excluded from aortic valvuloplasty. Although inhospital mortality
was higher in surgically treated patients (12% vs 9%) the 5-year survival of valve
replacement was much better than those treated with balloon valvuloplasty (71% vs
7%). Our selection of patients and immediate results of valvuloplasty are comparable
to seven published series. Aortic balloon valvuloplasty should not be used as a routine
or elective procedure for treatment of adult patients with aortic stenosis. It could,
however, be considered as a “bridge” procedure to stabilize high-risk patients before
surgical replacement of the valve.
