Daly Michael J, Monaghan Monica, Hamilton Andrew, Lockhart Christopher, Kodoth Vivek, Pillai Shevanthi, Manoharan Ganesh, Spence Mark S
Heart Centre, Royal Victoria Hospital, Grosvenor Road, Belfast, UK.
J Invasive Cardiol. 2012 Feb;24(2):58-62.
With the introduction of transcatheter aortic valve implantation (TAVI), the precise role of balloon aortic valvuloplasty (BAV) remains to be established.
Between August 2008 and November 2010, consecutive patients undergoing BAV for severe aortic stenosis (AS) in our center were enrolled. The primary endpoint was survival to hospital discharge. Secondary endpoints were 30-day survival and progression to aortic valve replacement (AVR).
Enrolled were 64 patients (age, 82 ± 8 years; 45% male). Treatment objectives were: symptom palliation (69%); potential AVR (23%); and facilitation of withdrawal of ventilation or non-cardiac surgery (8%). At baseline, patients had logistic EuroSCORE of 35.7 ± 19.5, NT-proBNP of 11,195 ± 11,694 ng/L, aortic valve area of 0.53 ± 0.17 cm², and peak transaortic gradient (PG) of 75.2 ± 25.3 mm Hg. The primary endpoint of survival to hospital discharge was reached by 97% patients. The secondary endpoint of 30-day mortality occurred in 8 patients (13%). Overall, 12 patients showed clinical improvement within 1 month of BAV. Of these, 8 patients underwent AVR (TAVI in 3/8 [38%]). After multivariate adjustment, the strongest correlates for 30-day survival and progression to AVR pre-BAV were: New York Heart Association ≤II, SBP ≥90 mm Hg, estimated glomular filtration rate ≥45 mL min-1, left ventricular ejection fraction ≥45% and transaortic PG <80 mm Hg.
In patients with severe AS and high operative risk, BAV has the potential to facilitate progression to TAVI in those who are technically suitable.
随着经导管主动脉瓣植入术（TAVI）的引入，球囊主动脉瓣成形术（BAV）的确切作用仍有待确定。
2008年8月至2010年11月，纳入了在我们中心因严重主动脉瓣狭窄（AS）接受BAV的连续患者。主要终点是存活至出院。次要终点是30天存活率和进展为主动脉瓣置换术（AVR）。
纳入64例患者（年龄82±8岁；45%为男性）。治疗目标为：缓解症状（69%）；潜在的AVR（23%）；以及促进撤机或非心脏手术（8%）。基线时，患者的逻辑EuroSCORE为35.7±19.5，NT-proBNP为11,195±11,694 ng/L，主动脉瓣面积为0.53±0.17 cm²，跨主动脉峰值梯度（PG）为75.2±25.3 mmHg。97%的患者达到了存活至出院这一主要终点。30天死亡率这一次要终点发生在8例患者中（13%）。总体而言，12例患者在BAV后1个月内临床症状改善。其中，8例患者接受了AVR（3/8 [38%]接受了TAVI）。多因素调整后，BAV前30天存活和进展为AVR的最强相关因素为：纽约心脏协会分级≤II级、收缩压≥90 mmHg、估计肾小球滤过率≥45 mL·min⁻¹、左心室射血分数≥45%以及跨主动脉PG<80 mmHg。
在严重AS且手术风险高的患者中，BAV有可能促进技术上合适的患者进展为TAVI。
