Balloon valvuloplasty in rheumatic aortic valve stenosis: immediate and long-term results

• Published in: Cardiovascular intervention and therapeutics Vol. 30; no. 1; pp. 45 - 50
• Main Authors: Pillai, Ajith Ananthakrishna, Ramasamy, Chandramohan, Saktheeshwaran, Maheshkumar, Selvaraj, Raja, Satheesh, Santhosh, Jayaraman, Balachander
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.01.2015
• Subjects: Aged; Aortic Valve Stenosis - surgery; Balloon Valvuloplasty - adverse effects; Balloon Valvuloplasty - methods; Cardiology; Cohort Studies; Female; Follow-Up Studies; Humans; Interventional Radiology; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Postoperative Complications; Retrospective Studies; Rheumatic Heart Disease - surgery; Survival Analysis; Treatment Outcome; Balloon aortic valvuloplasty; Rheumatic heart disease; Commissural splitting; Multivalve stenosis; Combined valvuloplasty
• ISSN: 1868-4300; 1868-4297; 1868-4297
• DOI: 10.1007/s12928-014-0286-0

To study the immediate and long-term results of balloon aortic valvuloplasty (BAV) in a large cohort of patients with rheumatic valvular aortic stenosis. Single tertiary care center retrospective data analysis of immediate and long-term outcomes in patients following BAV from 2000 to 2008. Ninety-two patients with rheumatic aortic stenosis (AS) were studied who underwent BAV. Mean age of patients was 21.7 years (95 % CI 14.3–28.9) with mean follow-up period of 5.7 years (±SD 1.3). Intervention resulted in successful BAV (more than 50 % reduction in baseline gradient) in 79 (85.9 %) subjects (Group A) and partially successful BPV (<50 % reduction in baseline gradient) in 8 (8.7 %) subjects (Group B). BAV failed in 5 (5.4 %) subjects (Group C). Concomitant balloon mitral valvuloplasty was done in 23/92 cases. Mean left ventricular systolic pressure decreased from 165.6 (95 % CI 142.7–196.3) to 110.9 mmHg (95 % CI 92.1–129.6), ( P  < 0.001) and mean aortic valve (AV) gradient from 50.7 (95 % CI 35.12–66.22) to 27.2 mmHg (95 % CI 25.83–31.23), ( P  < 0.001). The mean change in ejection fraction and mean AV gradient were significantly different between success (Groups A and B) and failure groups ( P  < 0.001). Different grades of aortic regurgitation were noted in 32 (34.78 %) patients post BAV (severe regurgitation in 2.18 %). Anova post hoc analysis showed sustained gradient reductions at 1- and 5-year follow-up ( P  > 0.05). The need for surgery was much lower in Group A (2.5 %) compared to Group B (50 %) and C (100 %). BAV is an effective treatment strategy in dominant AS in multi valvular rheumatic disease situations. Combined aortic and mitral valvuloplasty was performed in one-fourth of study patients.