[Percutaneous aortic valvuloplasty in adults: prediction of the immediate result and current indications]

Abstract

Here we present a series of 45 patients (21 M and 24 F) between the ages of 36 and 91 (average age: 71 +/- 8), who underwent Percutaneous Aortic Valvuloplasty (PAV) between Oct. 1986 and Dec. 1989. We used the traditional retrograde technique with balloon catheters sized 20 or 23 mm, with the exception of the first stage in which the kissing balloon technique was used in 7 cases. The calculated mean increase in aortic valve area (AVA) was 55.6 +/- 38% (from 0.49 +/- 0.11 cm2 to 0.74 +/- 0.07 cm2) and the peak gradient was reduced from 83 +/- 16 to 41 +/- 13 mmHg. We could observe only two relevant complications, i.e., two pulsating femoral artery haematomas at the site of catheter insertion. This artery underwent elective surgical resection two weeks after PAV. The dishomogeneity of the survey, due not only to the complexity of the valvular stenosis functional anatomy, but also to the changes in the PAV indications observed during the three-year period, led us to appraise our results by using a score based on the following features: valvular calcification degree (0-2); commissural fusion extent (0-4); bicuspid of tricuspid valve (0-2); and predilatation valve area less than 0.5 or greater than or equal to 0.5 cm2. In this way we were able to identify two groups of patients, one having a score of less than or equal to 6 (group I, 25 patients) and the other having a score of greater than or equal to 8 (group II, 20 patients). Mean AVA increase was 29% in group I and 84% in group II. At 24 +/- 6 months clinical follow-up, a significant discrepancy was maintained; the two groups showed a 5% and a 37.5% improvement, respectively. The score we suggest seems to single out cases with a high likelihood of success, i.e. the achievement of an AVA higher than 0.9 cm2. This seems to be helpful for a better selection of patients. Using this score as the basis for such an immediate result predictability, we believe that PAV could be advisable in the following cases: a) palliation for elderly patients (greater than 80 years) or patients with contraindications for valve replacement; b) as a bridge to surgical intervention; c) emergency procedures such as bailout valvuloplasty; d) diagnostic clarification in the most complex cases where a severe reduction in ventricular function and cardiac output, together with a low transvalvular gradient are present.