Aortic valvuloplasty for calcific aortic stenosis in the adult.

From July, 1971, through February, 1979, thirty-eight highly selected adult patients with symptomatic aortic stenosis (N.Y.H.A. Class III to IV) underwent aortic valvuloplasty rather than valve replacement. The choice of aortic valvuloplasty was based on the presence of one or more of the following factors: advanced age (over 75 years), calcification of the aorta and/or aortic annulus, small aortic annulus, severe coronary artery disease, poor left ventricular function (ejection fraction less than 25%), difficulty in coronary cannulation, or contraindication to anticoagulation. In addition, patients with the combination of severe coronary artery disease and aortic stenosis of insufficient severity to warrant valve replacement were teated by aortic valvuloplasty at the time of coronary artery bypass. The gradient across the aortic valve averaged 61.7 mmHg preoperatively and 8.4 mmHg postoperatively. There were two operative deaths (one from pre-existing renal failure) and two late deaths (pulmonary embolus and CHF). No patients were lost to follow-up. Thirty-two of thirty-four surviving patients experienced initial functional improvement. Five patients developed recurrent aortic stenosis (mean time 42.8 months after operation); and four required reoperation. The five year actuarial survival was 85.7% with a mean follow-up period of 24.8 months (range 1 to 91 months). The results in this high-risk subset of patients suggest that aortic valvuloplasty has a definite place in the treatment of selected cases of aortic stenosis.