Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California, USA.
Catheter Cardiovasc Interv. 2010 Apr 1;75(5):794-8. doi: 10.1002/ccd.22355.
To determine the safety and immediate efficacy after balloon aortic valvuloplasty (BAV) with a new, low-profile balloon.
BAV has a continuing role in the management of high-risk patients with severe aortic stenosis (AS). BAV with traditional noncompliant balloons requires a large femoral arteriotomy and is associated with high rates of access site complications.
We retrospectively reviewed medical records of 20 consecutive patients undergoing BAV for severe AS. Retrograde transfemoral BAV was performed with a low-profile, compliant valvuloplasty balloon. Before and after BAV, transaortic gradients were measured invasively and by echocardiography, and aortic valve area (AVA) calculated. Access site complications, functional class and survival were recorded.
Patients were 79 +/- 12 years old and had an estimated mortality from open aortic valve replacement of (12.5 +/- 9.6)%. By catheterization, mean aortic gradient fell from 44 +/- 15 to 29 +/- 10 mm Hg (P < 0.001) and AVA increased from 0.63 +/- 0.22 to 0.89 +/- 0.33 cm(2) (P < 0.001). New York Heart Association functional class improved from 3.5 +/- 0.7 to 2.7 +/- 0.8. Procedural mortality was 0%. There were no vascular complications or significant worsening of aortic regurgitation.
Transfemoral BAV using a low-profile compliant balloon is feasible with acceptable immediate results and safety.
评估新型低剖面球囊经皮球囊主动脉瓣成形术（BAV）的安全性和即刻疗效。
对于高危重度主动脉瓣狭窄（AS）患者，BAV 仍具有重要的治疗作用。传统非顺应性球囊进行 BAV 需要进行较大的股动脉切开术，且与较高的入路并发症发生率相关。
我们回顾性分析了 20 例连续接受重度 AS 行经皮球囊主动脉瓣成形术治疗的患者的病历资料。经逆行股动脉入路，使用低剖面顺应性球囊进行 BAV。在 BAV 前后，通过经胸超声心动图和经导管测量跨主动脉梯度，并计算主动脉瓣口面积（AVA）。记录入路并发症、心功能分级和生存情况。
患者年龄为 79 ± 12 岁，行开放主动脉瓣置换术的预估死亡率为（12.5 ± 9.6）%。经导管测量，平均主动脉瓣跨瓣压差从 44 ± 15mmHg 降至 29 ± 10mmHg（P < 0.001），AVA 从 0.63 ± 0.22cm²增至 0.89 ± 0.33cm²（P < 0.001）。纽约心功能分级从 3.5 ± 0.7 级改善至 2.7 ± 0.8 级。手术死亡率为 0%。无血管并发症或主动脉瓣反流加重。
经股动脉使用低剖面顺应性球囊行 BAV 是可行的，即时疗效和安全性可接受。
