Cribier A, Letac B
Centre Hospitalier and Universitaire de Rouen, France.
Curr Opin Cardiol. 1991 Apr;6(2):212-8. doi: 10.1097/00001573-199104000-00006.
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.
在我们的系列研究中，经过5年经皮气囊主动脉瓣成形术的经验以及对550多名因钙化性主动脉瓣狭窄而接受扩张治疗的患者的观察，该方法的局限性已得到充分认识，并且对其适应证也进行了回顾。迄今为止，两个主要适应证是手术风险增加的高龄患者以及病情危重的患者，在这些患者中该手术最常被用作手术的桥梁。在我们的180例八旬和九旬老人系列中，他们存在多种增加围手术期死亡率预测的因素，我们表明该技术能够有效缓解症状并提高生存率。然而，对于其他方面健康且活跃的老年患者，仍建议进行瓣膜置换。气囊主动脉瓣成形术对于伴有严重左心室功能障碍和严重心力衰竭的危重患者也显然有用，特别是对于心源性休克患者，它可能挽救生命。最常见的是左心室功能得到显著改善，从而使瓣膜置换能够在风险降低到可接受水平后进行。气囊主动脉瓣成形术在经验丰富的医生手中是一种低成本、低风险的手术，仅需局部麻醉且住院时间短，它可部分减轻主动脉瓣狭窄，但在许多情况下可能是改善患者病情的唯一有价值的治疗选择。
