Short-term clinical and haemodynamic assessment of balloon aortic valvuloplasty in 30 elderly patients. Discrepancy between immediate and eighth-day haemodynamic values

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Abstract
Recently, percutaneous aortic valvuloplasty has been considered as a possible palliative procedure in elderly patients with critical valvular stenosis in whom valve replacement is deferred or contra-indicated because of high operative risk. However, the demonstration of the efficacy of such a procedure is based on immediate post dilatation haemodynamic data and clinical improvement. The purpose of this study was to evaluate the haemodynamic consequences of this procedure on the eighth day after a post procedure haemodynamic control. Thirty consecutive patients (mean age 75±8·4 years) with long-standing aortic stenosis were treated at the time of cardiac catheterization with balloon dilatation. Of these 30 patients, 24 (mean age 76±8) underwent haemodynamic evaluation eight days after the procedure. Prevalvuloplasty examination revealed a mean aortic valve gradient (MAVG) of 82±19·9 mmHg, a mean thermodilution calculated cardiac output (CO) of 3·6±0·91 min−1 and a mean aortic valve area (VA) of 0·37±0·14 cm2. Immediate postvalvuloplasty control showed a fall in MAVG to 44·5±16·7 mmHg (P≤0·001), a decrease in CO to 3·3±1·4 lmin−1 (NS) and an increase in VA to 0·60±0·35 cm2 (P≤0·01). Eighth-day haemodynamic control revealed an increase in MAVG to 71±18·8 mmHg (P≤0·001), an increase in CO to 4·1±1·3 lmin−1 (P≤0·001) and a decrease in VA down to 0·47±0·10 cm2 (P≤0·03). However, the comparison of the prevalvuloplasty data and the eighth-day haemodynamic control show: first, that the MAVG decreases from 81·8 to 71·3 mmHg (P≤0·01) but remains significant; second, the VA rises from 0·37±0·14 to 0·47±0·18 cm2 (P≤0·01) and remains within the limits of severe aortic stenosis. Real post valvuloplasty aortic valve modifications may be responsible for the slight but significant decrease of the MAVG and increase of VA on the eight-day control. However, the secondary important fall in mean aortic valve gradient and increase of valve area are probably also, in part, the consequence of a brief but considerable increase of the charge conditions superimposed to the left ventricle during the balloon inflation. Moreover, blood depletions added to arrhythmias and vaso-vagal phenomena are probably also responsible for modifications of charge conditions and, in our opinion, for the optimization of immediate post-valvuloplasty results.

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