Percutaneous balloon aortic valvuloplasty in adults with calcific aortic stenosis.

After 5 years' experience with percutaneous balloon aortic valvuloplasty and more than 550 patients dilated for calcific aortic stenosis in our series, the limits of the method are well recognized, and the indications have been reviewed. To date, the two main indications are very old patients with increased surgical risks and critically ill patients in whom the procedure is most often used as a bridge to surgery. From our series of 180 octogenarians and nonagenarians with several factors increasing the predicted perioperative mortality, we showed that the technique is able to efficiently palliate the symptoms and improve survival. Valve replacement remains, however, recommended in otherwise healthy and active elderly patients. Balloon aortic valvuloplasty is also clearly useful in critically ill patients with major left ventricular dysfunction and severe heart failure, especially in patients with cardiogenic shock in whom it may be life saving. A dramatic improvement of left ventricular function is most generally obtained, allowing valve replacement to be performed later with an acceptable lowered risk. Balloon aortic valvuloplasty, a low-cost and low-risk procedure in experienced hands, requiring only local anesthesia and a short hospitalization stay, partially reduces aortic stenosis but may in many cases be the only valuable therapeutic option for patient improvement.