Balloon valvuloplasty in adult aortic stenosis: determinants of clinical outcome

Ann Intern Med. 1989 Mar 15;110(6):421-5. doi: 10.7326/0003-4819-110-6-421.


Study objective: To determine the clinical variables affecting outcome after balloon aortic valvuloplasty.

Design: Longitudinal follow-up of consecutive case series.

Patients: Consecutive sample of 36 patients with severe calcific aortic stenosis, and without active infection or left ventricular mural thrombus.

Interventions: Percutaneous transluminal dilatation of the aortic valve until the peak gradient was reduced by 50% or a maximal balloon size was used. Hemodynamic measurements taken before and after dilatation.

Measurements and main results: Thirty-three patients had a successful dilatation. Eighty-nine percent (95% confidence interval [CI]. 74% to 97%) improved symptomatically at 2 weeks, but by 26 weeks only 56% (CI, 35% to 76%) remained improved (P = 0.0078). Mortality rates were high at 8 (9%) and 26 (28%) weeks. Predictors of adverse events included left ventricular ejection fraction (P = 0.04, r = 0.46), pulmonary artery systolic pressure (P = 0.048, r = 0.65), pulmonary vascular resistance (P = 0.008, r = 0.69), and right ventricular end-diastolic pressure (P = 0.009, r = 0.43) at 8 weeks and all these factors except left ventricular ejection fraction at 26 weeks. These clinical outcomes were unrelated to other cardiac or pulmonary diseases.

Conclusions: Symptomatic improvement is only temporary in many patients undergoing balloon aortic valvuloplasty, and the mortality rate in the mid-term follow-up period is high. Valve surgery remains the treatment of choice for aortic stenosis in the adult.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / therapy*
  • Blood Pressure
  • Cardiac Catheterization
  • Catheterization* / adverse effects
  • Catheterization* / mortality
  • Clinical Trials as Topic
  • Diastole
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Pressure
  • Pulmonary Artery
  • Stroke Volume
  • Vascular Resistance