Szerlip Molly, Arsalan Mani, Mack Molly C, Filardo Giovanni, Worley Christina, Kim Rebeca J, Phan Teresa, Pollock Benjamin, Rangel Cynthia, Brown David L, Mack Michael, Holper Elizabeth M
Interventional Cardiology, The Heart Hospital Baylor Plano, Plano, Texas.
Cardiovascular Research, Baylor Research Institute, Dallas, Texas; Cardiothoracic Surgery, Kerckhoff-Klinik, Bad-Nauheim, Germany.
Am J Cardiol. 2017 Oct 15;120(8):1366-1372. doi: 10.1016/j.amjcard.2017.07.024. Epub 2017 Jul 25.
We aim to evaluate the contemporary role and outcomes of balloon aortic valvuloplasty (BAV), based on physician intent, for the management of severe aortic stenosis. This is a prospective, 2-center study of 100 consecutive high-risk patients with severe aortic stenosis who underwent BAV. Before BAV, physicians assigned intent as (1) bridge to decision (BTD); (2) therapeutic bridge to planned therapy; or (3) palliation. Patients in the BTD arm underwent clinical assessment at 30 days to determine eligibility for definitive valve therapy. All patients were followed up to 1 year, with outcomes measured including procedural complications, Kansas City Cardiomyopathy Questionnaires scores, 30-day and 1-year mortality, and definitive valve therapy. Enrolled patients had a mean age of 80.6 (±9.6) years, Society of Thoracic Surgeons predicted risk of mortality of 11.4% (±7.1%), and 91 (91.0%) patients had class III or IV New York Heart Association congestive heart failure. Intent in the 100 study patients was 76 BTD; 20 therapeutic bridge to planned therapy; and 4 palliation. Thirty-day mortality for all patients was 6 of 100 (6.0%), and 1-year mortality for all patients who received definitive valve therapy was 6 of 54 (11.1%). For patients surviving to 30 days, adjusted (by Society of Thoracic Surgeons predicted risk of mortality) Kansas City Cardiomyopathy Questionnaires scores were significantly improved from baseline for all patients and BTD patients. In conclusion, as a bridge to decision and treatment tool, BAV appears to have a valuable role in properly selecting and improving patients to undergo definitive valve replacement.
我们旨在根据医生的治疗意图，评估球囊主动脉瓣成形术（BAV）在重度主动脉瓣狭窄治疗中的当代作用及治疗效果。这是一项前瞻性、双中心研究，纳入了100例连续接受BAV治疗的高危重度主动脉瓣狭窄患者。在进行BAV之前，医生将治疗意图分为：（1）决策过渡（BTD）；（2）计划性治疗的治疗过渡；或（3）姑息治疗。BTD组的患者在30天时接受临床评估，以确定是否适合确定性瓣膜治疗。所有患者均随访1年，测量的结局包括手术并发症、堪萨斯城心肌病问卷评分、30天和1年死亡率以及确定性瓣膜治疗情况。入组患者的平均年龄为80.6（±9.6）岁，胸外科医师协会预测的死亡风险为11.4%（±7.1%），91例（91.0%）患者为纽约心脏病协会III或IV级充血性心力衰竭。100例研究患者的治疗意图为：76例BTD；20例计划性治疗的治疗过渡；4例姑息治疗。所有患者的30天死亡率为100例中的6例（6.0%），接受确定性瓣膜治疗的所有患者的1年死亡率为54例中的6例（11.1%）。对于存活至30天的患者，经胸外科医师协会预测的死亡风险调整后，所有患者和BTD组患者的堪萨斯城心肌病问卷评分较基线均有显著改善。总之，作为一种决策过渡和治疗工具，BAV似乎在正确选择和改善患者接受确定性瓣膜置换方面具有重要作用。
