Balloon valvuloplasty in rheumatic aortic valve stenosis: immediate and long-term results
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ORIGINAL ARTICLE
Balloon valvuloplasty in rheumatic aortic valve stenosis: immediate and long-term results Ajith Ananthakrishna Pillai • Chandramohan Ramasamy • Maheshkumar Saktheeshwaran • Raja Selvaraj • Santhosh Satheesh Balachander Jayaraman
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Received: 3 April 2014 / Accepted: 13 July 2014 / Published online: 29 July 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
Abstract To study the immediate and long-term results of balloon aortic valvuloplasty (BAV) in a large cohort of patients with rheumatic valvular aortic stenosis. Single tertiary care center retrospective data analysis of immediate and long-term outcomes in patients following BAV from 2000 to 2008. Ninety-two patients with rheumatic aortic stenosis (AS) were studied who underwent BAV. Mean age of patients was 21.7 years (95 % CI 14.3–28.9) with mean follow-up period of 5.7 years (±SD 1.3). Intervention resulted in successful BAV (more than 50 % reduction in baseline gradient) in 79 (85.9 %) subjects (Group A) and partially successful BPV (\50 % reduction in baseline gradient) in 8 (8.7 %) subjects (Group B). BAV failed in 5 (5.4 %) subjects (Group C). Concomitant balloon mitral valvuloplasty was done in 23/92 cases. Mean left ventricular systolic pressure decreased from 165.6 (95 % CI 142.7–196.3) to 110.9 mmHg (95 % CI 92.1–129.6), (P \ 0.001) and mean aortic valve (AV) gradient from 50.7 (95 % CI 35.12–66.22) to 27.2 mmHg (95 % CI 25.83–31.23), (P \ 0.001). The mean change in ejection fraction and mean AV gradient were significantly different between success (Groups A and B) and failure groups (P \ 0.001). Different grades of aortic regurgitation were noted in 32 (34.78 %) patients post BAV (severe regurgitation in 2.18 %). Anova post hoc analysis showed sustained gradient reductions at 1- and 5-year follow-up (P [ 0.05). The need for surgery was much lower in Group A (2.5 %) compared to Group B (50 %) and C (100 %). BAV is an effective treatment strategy in dominant AS in
A. A. Pillai (&) C. Ramasamy M. Saktheeshwaran R. Selvaraj S. Satheesh B. Jayaraman Department of Cardiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry 605006, India e-mail: [email protected]
multi valvular rheumatic disease situations. Combined aortic and mitral valvuloplasty was performed in onefourth of study patients. Keywords Balloon aortic valvuloplasty Rheumatic heart disease Multivalve stenosis Combined valvuloplasty Commissural splitting
Introduction Rheumatic heart disease is still highly prevalent in Asian countries with frequent involvement of aortic valve causing aortic stenosis (AS) through commissural fusion. While balloon aortic valvuloplasty (BAV) is considered therapeutic in congenital AS due to bicuspid aortic valve [1] and palliative in degenerative AS [2], the role of BAV in rheumatic AS is unclear. Published series involving small number of patients show good immediate response to this procedure [3]. This retrospective cohort study was designed to analyze the
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