Vol. 35 No. 1 (2020): Revista Uruguaya de Cardiología
Artículos originales de investigación

Percutaneous aortic valvuloplasty in severe adult aortic stenosis: indications, morbidity and mortality. Analysis of the aortic valvuloplasty registry of an university cardiovascular center

  • Juan Albistur,
  • Gimena Loza,
  • Juan Pablo Bachini,
  • Pedro Trujillo,
  • Rafael Mila,
  • Álvaro Niggemeyer,
  • Ariel Durán,
  • Gustavo Vignolo,
Juan Albistur
Centro Cardiovascular Universitario. Hospital de Clínicas, Universidad de la República. Montevideo, Uruguay.
Published 17-03-2020

Keywords:

AORTIC VALVE STENOSIS, PERCUTANEOUS AORTIC VALVULOPLASTY, TRANSCATHETER AORTIC VALVE REPLACEMENT

Abstract

Introduction: severe aortic stenosis is frequent and valve replacement is the only effective treatment. Percutaneous aortic valvuloplasty has transient benefits, and its indication is restricted to unstable patients as a bridge to other treatment or palliative therapy. In our country, there is a few evidence of this technique.
Objective: to determine the indication, efficacy, complications and mortality of percutaneous aortic valvuloplasty performed in our center between January 2006 - September 2018. Secondarily, to determine which was the definitive therapy and it´s delay.
Method: retrospective and descriptive study. All patients who received valvuloplasty during the study period were included. Clinical histories were reviewed. Qualitative variables were presented in absolute value and percentage; the
quantitative ones, in median and interquartile interval. Wilcoxon test was applied to dependent variables, p <0.05. Kaplan Meier curves were performed to analize survival. Protocol was approved by ethics committee.
Results: 28 cases. 17 (60.7%) were female. Average age was 79.5 years (IQ 73-85.5). The objective of percutaneous aortic valvuloplasty was bridge therapy to decision in 11 cases (39.2%), bridge to definitive treatment in 12 (42.8%) and palliative in 5 (18%). The most frequent indications were: refractory heart failure in 10 cases (35.7%) and cardiogenic shock in 9 (32.1%). Valvuloplasty was successful in 57.1% of cases. 19 patients died (67.8%). The median survival was 59 days (IQ 5-412). 6 patients received definitive treatment (4 percutaneous implantation and 2 open cardiac surgery). The time from percutaneous aortic valvuloplasty to percutaneous aortic valve implantation was 233 days and 47 days to open surgery.
Conclusions: the most frequent indications for percutaneous aortic valvuloplasty were bridge therapy to definitive treatment and decision. Percutaneous aortic valvuloplasty was successful in more than 50% of cases. Major complications determined the prognosis. Mortality was high at follow-up.Asmall number acceded to definitive treatment (predominantly percutaneous implantation).

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