Dorros G, Lewin R F, Stertzer S H, King J F, Waller B F, Myler R K, Mathiak L, Murphy M, Shaw R E, Assa J
Department of Cardiology, St. Luke's Medical Center, Milwaukee, Wisconsin.
Eur Heart J. 1990 May;11(5):429-40. doi: 10.1093/oxfordjournals.eurheartj.a059726.
Double balloon percutaneous transluminal aortic valvuloplasty (PTAV) was performed on 149 patients (76 male (51%), mean age 76 +/- 11 years) whose symptoms included severe congestive heart failure in 127 cases (82%), syncope in 21 (14%) and angina in six (4%). Significant changes (P less than 0.05) in peak systolic (83 +/- 36 to 38 +/- 30 mmHg) and mean gradient (68 +/- 25 to 36 +/- 21 mmHg), and aortic valve area (0.6 +/- 0.2 to 1.0 +/- 0.4 cm2) were achieved in 130/149 patients (87%). Complications included an overall in-hospital mortality of 13%, (10.0% excluding the six deaths occurring in 18 moribund patients), a neurologic deficit incidence of 3%, and surgical arterial entry site repair 3.0% (14/47) of patients. Multivariate analysis identified congestive heart failure (NYHA Class IV), left ventricular ejection fraction, cardiac output and coronary artery disease as independent variables significantly affecting in-hospital mortality. Predictors of poor long-term survival were degree of heart failure, and coronary artery disease. The cumulative probability of survival at 24 months was 52 +/- 5% (excluding non-cardiac deaths, was 66 +/- 3%). Follow-up (mean time: 16 +/- 7 months) of 130 patients discharged alive revealed 41 late deaths (26 cardiac related). Sixty-two patients (70%) were symptomatically improved; 17 patients had symptom recurrence and underwent repeat valvuloplasty, and 10 patients valve replacement. Follow-up catheterization of 18 asymptomatic patients revealed that 11 patients had silently restenosed. These data indicate that aortic valvuloplasty is a palliative therapy for elderly patients, who are poor surgical candidates, with symptomatic calcific aortic stenosis with reasonable clinical success and long-term survival when considering their clinical status, but with a significant restenosis rate.
对149例患者（76例男性（51%），平均年龄76±11岁）实施了双球囊经皮腔内主动脉瓣成形术（PTAV），这些患者的症状包括127例（82%）严重充血性心力衰竭、21例（14%）晕厥和6例（4%）心绞痛。130/149例患者（87%）的收缩期峰值（从83±36 mmHg降至38±30 mmHg）、平均压差（从68±25 mmHg降至36±21 mmHg）以及主动脉瓣面积（从0.6±0.2 cm²增至1.0±0.4 cm²）有显著变化（P<0.05）。并发症包括总体住院死亡率为13%（排除18例濒死患者中的6例死亡后为10.0%）、神经功能缺损发生率为3%以及3.0%（14/47）的患者需要进行手术修复动脉穿刺部位。多因素分析确定充血性心力衰竭（纽约心脏协会IV级）、左心室射血分数、心输出量和冠状动脉疾病为显著影响住院死亡率的独立变量。长期生存不良的预测因素为心力衰竭程度和冠状动脉疾病。24个月时的累积生存概率为52±5%（排除非心脏性死亡后为66±3%）。对130例存活出院患者的随访（平均时间：16±7个月）显示有41例晚期死亡（26例与心脏相关）。62例患者（70%）症状改善；17例患者症状复发并接受了再次瓣膜成形术，10例患者接受了瓣膜置换术。对18例无症状患者的随访导管检查显示，11例患者发生了无症状性再狭窄。这些数据表明，主动脉瓣成形术是一种针对手术风险高的老年有症状钙化性主动脉瓣狭窄患者的姑息治疗方法，考虑到其临床状况，临床成功率合理且有长期生存，但再狭窄率较高。
