Palliative percutaneous aortic balloon valvuloplasty before noncardiac operations and invasive diagnostic procedures

Abstract

Percutaneous aortic balloon valvuloplasty (PABV) is useful in palliating symptoms of severe aortic stenosis in patients who are not candidates for aortic valve replacement. In 15 patients who had severe aortic stenosis and a contraindication to aortic valve replacement, PABV was performed before a noncardiac procedure, in an attempt to improve their hemodynamics and reduce the risks associated with the operation or preoperative diagnostic test. The mean aortic gradient was reduced from 58.1 +/- 6.0 mm Hg to 32.2 +/- 4.0 mm Hg (P less than 0.0002), and the aortic valve area was increased from 0.49 +/- 0.04 cm2 to 0.85 +/- 0.10 cm2 (P less than 0.0002). Complications associated with PABV included left ventricular perforation in three patients (which resulted in death in one of them), transient congestive heart failure in one, and development of femoral pseudoaneurysms in one. After PABV, nine patients underwent the planned surgical procedure under general anesthesia without complications. Five patients underwent surgical diagnostic procedures after PABV that resulted in a change in treatment strategy. Three of these patients required no further treatment, and two required resection of the colon for bleeding, which was preceded by aortic valve replacement. This study demonstrates that PABV may be useful in reducing the risks of noncardiac procedures in selected patients with severe aortic stenosis who are otherwise not candidates for aortic valve replacement.