Pedersen Wes R, Goldenberg Irvin F, Pedersen Christopher W, Lesser Andrew, Harris Kevin M, Lesser John R, Garberich Ross F, Schwartz Jonathan G, Shank Emily, Schwartz Robert S
Structural Heart Disease Program, Cardiovascular Services, Minneapolis Heart Institute® at Abbott Northwestern Hospital, Minneapolis, Minnesota; Research Department, Minneapolis Heart Institute Foundation™, Minneapolis, Minnesota.
Catheter Cardiovasc Interv. 2014 Nov 1;84(5):824-31. doi: 10.1002/ccd.25328. Epub 2014 Aug 8.
To determine outcomes following balloon aortic valvuloplasty (BAV) in aortic stenosis (AS) patients with a left ventricular ejection fraction (LVEF) <20%.
Severe AS patients with a LVEF <20% are excluded from United States (U.S.) transcatheter aortic valve replacement (TAVR) trials and often surgical aortic valve replacement (AVR). The role for BAV to enhance LVEF is unclear.
Our BAV database of 270 consecutive patients extending from 2005 through 2010 was queried for a preoperative LVEF <20%. Demographics, echocardiograms, procedural technique, and outcomes were analyzed. Pre- and postoperative echocardiograms were used to determine improvement in aortic valve area (AVA) and LVEF.
Sixteen patients were identified with a median age of 82 years. The composite Society of Thoracic Surgeons' (STS) mortality risk was 16.4%. The median preoperative AVA and LVEF were 0.60 cm(2) and 16%, respectively, and postoperative AVA and LVEF were 0.77 cm(2) and LVEF 19%, respectively. About 15 of the 16 patients had postoperative echocardiograms available for comparison. And 7 of these 15 (47%) demonstrated improvement in LVEF to ≥20% (median LVEF 25%). The absence of coronary disease and improvement in AVA of ≥0.2 cm(2) was associated with postoperative LVEF of ≥20%. Procedural mortality was 0%. The 30-day, 6-month, and 1-year survival was 69%, 56%, and 29%. STS's mortality risk score ≥15% was associated with short-term mortality.
With appropriate technique, BAV can be reasonably safe in patients with LVEF <20%. Roughly half of these patients demonstrated improvement in LVEF to ≥20%.
确定左心室射血分数（LVEF）<20%的主动脉瓣狭窄（AS）患者接受球囊主动脉瓣成形术（BAV）后的结局。
LVEF<20%的重度AS患者被排除在美国经导管主动脉瓣置换术（TAVR）试验之外，并且通常也不适合接受外科主动脉瓣置换术（AVR）。BAV对提高LVEF的作用尚不清楚。
查询我们从2005年至2010年连续270例患者的BAV数据库，以获取术前LVEF<20%的患者。分析人口统计学、超声心动图、手术技术和结局。术前和术后超声心动图用于确定主动脉瓣面积（AVA）和LVEF的改善情况。
确定了16例患者，中位年龄为82岁。胸外科医师协会（STS）综合死亡风险为16.4%。术前AVA和LVEF的中位数分别为0.60 cm²和16%，术后AVA和LVEF分别为0.77 cm²和19%。16例患者中有15例术后有超声心动图可供比较。这15例中的7例（47%）LVEF改善至≥20%（LVEF中位数为25%）。无冠心病以及AVA改善≥0.2 cm²与术后LVEF≥20%相关。手术死亡率为0%。30天、6个月和1年生存率分别为69%、56%和29%。STS死亡风险评分≥15%与短期死亡率相关。
采用适当技术时，BAV对于LVEF<20%的患者可能相当安全。这些患者中约一半LVEF改善至≥20%。
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