Kastrup J, Wennevold A, Thuesen L, Nielsen T T, Kassis E, Fritz-Hansen P, Thayssen P
Department of Internal Medicine, Rigshospitalet, Copenhagen, Denmark.
Dan Med Bull. 1994 Jun;41(3):362-5.
Percutaneous transluminal balloon aortic valvuloplasty was performed in 137 patients with symptomatic severe calcified aortic stenosis (50 men and 87 women, mean age 77 years) between December 1986 and September 1990. The purpose of the study was to evaluate short- and long-term survival after balloon aortic valvuloplasty, mean follow-up was 19 months. At the time of balloon aortic valvuloplasty congestive heart failure (NYHA III-IV) was present in 89%, angina pectoris in 47%, and syncope in 31% of the patients. Aortic balloon dilatation produced significant decreases in peak pressure gradient from 91 +/- 34 mmHg to 40 +/- 26 mmHg (p < 0.001). The procedure related mortality was 8% (11 pts) and the 30-days mortality 17% (23 pts). Severe complications occurred in 25% of the patients during the procedure and within the first 24 hours. Immediate clinical improvement was noted in 68% of the patients surviving the treatment. The overall survival rate was at one, two, three and four years follow-up 63%, 40%, 28%, and 21%, respectively. These survival rates were all statistically different from the survival rates in an age- and sex-matched background population (p < 0.001). A multivariate Cox analysis revealed that only female sex and angina before treatment seemed to improve survival.
The long-term outcome after aortic balloon valvuloplasty for severe aortic stenosis is so poor that we recommend aortic valve replacement as the initial treatment in these patients, if at all possible.
1986年12月至1990年9月期间，对137例有症状的重度钙化性主动脉瓣狭窄患者（50例男性，87例女性，平均年龄77岁）实施了经皮腔内球囊主动脉瓣成形术。本研究的目的是评估球囊主动脉瓣成形术后的短期和长期生存率，平均随访时间为19个月。在进行球囊主动脉瓣成形术时，89%的患者存在充血性心力衰竭（纽约心脏协会III-IV级），47%的患者有胸痛，31%的患者有晕厥。主动脉球囊扩张使峰值压力阶差从91±34 mmHg显著降至40±26 mmHg（p<0.001）。手术相关死亡率为8%（11例），30天死亡率为17%（23例）。25%的患者在手术过程中和术后24小时内出现严重并发症。在接受治疗存活的患者中，68%有即刻临床改善。在1年、2年、3年和4年随访时的总生存率分别为63%、40%、28%和21%。这些生存率与年龄和性别匹配的背景人群的生存率均有统计学差异（p<0.001）。多因素Cox分析显示，只有女性性别和治疗前的胸痛似乎能改善生存率。
重度主动脉瓣狭窄患者接受主动脉球囊瓣成形术后的长期预后很差，因此我们建议，只要有可能，应将主动脉瓣置换作为这些患者的初始治疗方法。
