[Aortic valve replacement after aortic valvuloplasty for calcified aortic stenosis. A propos of 104 patients].

Between February 1987 and December 1990, 104 patients (48 men, 56 women) with an average age of 69 years, underwent aortic valve replacement (AVR) after one or several percutaneous aortic valve balloon dilatation. Thirty one patients were in Class II and 73 patients in Classes III and IV. Twenty two patients had angina (16 Class I-II, 6 Class III-IV) and 12 patients had syncope or near syncope on effort. The indications of valvuloplasty were: non-definitive contraindications of surgery or a surgical risk which was estimated to be excessive (46 patients), a personal choice (41 patients). Five patients underwent preoperative dilatation because of the high operative risk; 7 patients refused surgery and 5 patients were operated as an emergency (2 mas-sive aortic regurgitations, 1 left ventricular perforation, 1 cardiogenic shock, 1 endocarditis with cardiogenic shock). The inter-val between dilatation and surgery was on average 472 days. The patients were improved over an average period of 261 days. Apart form the emergency cases, the patients were operated because of restenosis. Surgery consisted of 53 mechanical and 51 bioprosthetic valve replacements. There was an associated procedure in 17 cases (17 single bypass grafts, 2 double bypass, 1 triple bypass graft, 1 left ventricular suture, 1 Bigelow procedure, 2 mitral valve replacements, 1 tricuspid annuloplasty, 1 carotid endarteriectomy, 1 replacement of the ascending aorta, 1 closure of ASD). The operative mortality was 7 patients (6.7%). The operative findings were 8 lesions related to dilatation, mainly valve tears or disinsertions requiring rapid (6 cases) or emergency (2 cases) surgery for massive aortic regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)