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Balloon aortic valvuloplasty in adults: failure of procedure to improve long-term survival.

Publication ,  Journal Article
Lieberman, EB; Bashore, TM; Hermiller, JB; Wilson, JS; Pieper, KS; Keeler, GP; Pierce, CH; Kisslo, KB; Harrison, JK; Davidson, CJ
Published in: J Am Coll Cardiol
November 15, 1995

OBJECTIVES: This study sought to determine the long-term outcome of adult patients undergoing percutaneous balloon aortic valvuloplasty. BACKGROUND: Percutaneous balloon aortic valvuloplasty has been offered as an alternative to aortic valve replacement for selected patients with valvular aortic stenosis. Although balloon aortic valvuloplasty produces an immediate reduction in the transvalvular aortic gradient, a high incidence of restenosis frequently leads to recurrent symptoms. Therefore, it is unclear whether balloon aortic valvuloplasty impacts on the long-term outcome of these patients. METHODS: Clinical, hemodynamic and echocardiographic data were collected at baseline in 165 patients undergoing balloon aortic valvuloplasty and examined for their ability to predict long-term outcome. RESULTS: The median duration follow-up was 3.9 years (range 1 to 6). Ninety-nine percent follow-up was achieved. During this 6-year period, 152 patients (93%) died or underwent aortic valve replacement, and 99 (60%) died of cardiac-related causes. The probability of event-free survival (freedom from death, aortic valve replacement or repeat balloon aortic valvuloplasty) 1, 2 and 3 years after valvuloplasty was 40%, 19% and 6%, respectively. In contrast, the probability of survival 3 years after balloon aortic valvuloplasty in a subset of 42 patients who underwent subsequent aortic valve replacement was 84%. Survival after aortic valvuloplasty was poor regardless of the presenting symptom, but patients with New York Heart Association functional class IV congestive heart failure had events earliest. Univariable predictors of decreased event-free survival were younger age, advanced congestive heart failure symptoms, lower ejection fraction, elevated left ventricular end-diastolic pressure, presence of coronary artery disease and increased left ventricular internal diastolic diameter. Stepwise multivariable logistic regression analysis found that only younger age and a lower left ventricular ejection fraction contributed independent adverse prognostic information (chi-square 14.89, p = 0.0006). CONCLUSIONS: Long-term event-free and actuarial survival after balloon aortic valvuloplasty is dismal and resembles the natural history of untreated aortic stenosis. Aortic valve replacement may be performed in selected subjects with good results. However, the prognosis for the remainder of patients who are not candidates for aortic valve replacement is particularly poor.

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Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

November 15, 1995

Volume

26

Issue

6

Start / End Page

1522 / 1528

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Recurrence
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Echocardiography
 

Citation

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Lieberman, E. B., Bashore, T. M., Hermiller, J. B., Wilson, J. S., Pieper, K. S., Keeler, G. P., … Davidson, C. J. (1995). Balloon aortic valvuloplasty in adults: failure of procedure to improve long-term survival. J Am Coll Cardiol, 26(6), 1522–1528. https://doi.org/10.1016/0735-1097(95)00363-0
Lieberman, E. B., T. M. Bashore, J. B. Hermiller, J. S. Wilson, K. S. Pieper, G. P. Keeler, C. H. Pierce, K. B. Kisslo, J. K. Harrison, and C. J. Davidson. “Balloon aortic valvuloplasty in adults: failure of procedure to improve long-term survival.J Am Coll Cardiol 26, no. 6 (November 15, 1995): 1522–28. https://doi.org/10.1016/0735-1097(95)00363-0.
Lieberman EB, Bashore TM, Hermiller JB, Wilson JS, Pieper KS, Keeler GP, et al. Balloon aortic valvuloplasty in adults: failure of procedure to improve long-term survival. J Am Coll Cardiol. 1995 Nov 15;26(6):1522–8.
Lieberman, E. B., et al. “Balloon aortic valvuloplasty in adults: failure of procedure to improve long-term survival.J Am Coll Cardiol, vol. 26, no. 6, Nov. 1995, pp. 1522–28. Pubmed, doi:10.1016/0735-1097(95)00363-0.
Lieberman EB, Bashore TM, Hermiller JB, Wilson JS, Pieper KS, Keeler GP, Pierce CH, Kisslo KB, Harrison JK, Davidson CJ. Balloon aortic valvuloplasty in adults: failure of procedure to improve long-term survival. J Am Coll Cardiol. 1995 Nov 15;26(6):1522–1528.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

November 15, 1995

Volume

26

Issue

6

Start / End Page

1522 / 1528

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Recurrence
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Echocardiography