Holmes D R, Nishimura R A, Reeder G S, Wagner P J, Ilstrup D M
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Arch Intern Med. 1989 Jun;149(6):1405-9.
Percutaneous aortic balloon valvuloplasty has been applied in a growing number of patients with severe symptomatic calcific aortic stenosis. Follow-up data from these patients have not been well characterized. In 88 patients (mean age, 80 +/- 8 years) who underwent percutaneous aortic balloon valvuloplasty, the average initial aortic valve area was 0.48 +/- 0.20 cm2, and it increased to 0.74 +/- 0.26 cm2 after dilation. The average duration of follow-up in survivors was 7.8 months. Actuarial survival at 6 and 12 months was 75% and 63%, respectively. Factors associated with subsequent death included more severe impairment from heart failure at baseline, smaller initial aortic valve area, smaller final aortic valve area, low baseline cardiac output, and low ejection fraction. Among the surviving patients, 50% had no cardiac symptoms, and 85% had improved symptoms from congestive heart failure. Percutaneous aortic balloon valvuloplasty is associated with continued increased mortality during follow-up, although symptomatic improvement in survivors is good. Percutaneous aortic balloon valvuloplasty can be considered a palliative approach for severely symptomatic patients at high risk for aortic valve operation or patients with a limited life span due to other medical problems, but it is not indicated in patients at acceptably low risk for aortic valve replacement.
经皮主动脉球囊瓣膜成形术已应用于越来越多有严重症状的钙化性主动脉瓣狭窄患者。这些患者的随访数据尚未得到充分描述。在88例接受经皮主动脉球囊瓣膜成形术的患者（平均年龄80±8岁）中，初始主动脉瓣平均面积为0.48±0.20cm²，扩张后增至0.74±0.26cm²。存活患者的平均随访时间为7.8个月。6个月和12个月的精算生存率分别为75%和63%。与随后死亡相关的因素包括基线时心力衰竭导致的更严重损害、初始主动脉瓣面积较小、最终主动脉瓣面积较小、基线心输出量较低和射血分数较低。在存活患者中，50%没有心脏症状，85%的充血性心力衰竭症状有所改善。经皮主动脉球囊瓣膜成形术在随访期间死亡率持续增加，尽管存活患者的症状改善良好。经皮主动脉球囊瓣膜成形术可被视为主动脉瓣手术高风险的严重症状患者或因其他医疗问题预期寿命有限患者的一种姑息治疗方法，但对于主动脉瓣置换术风险可接受的低风险患者并不适用。
