Clinical Application of Percutaneous Balloon Aortic Valvuloplasty in Patients With Calcified Severe Aortic Stenosis Combining Heart Failure / 中国循环杂志

ABSTRACT

Objective: To assess the clinical application of percutaneous balloon aortic valvuloplasty (PBAV) in patients with calcified severe aortic stenosis (AS) combining heart failure (HF). Methods: A total of 15 relevant patients treated by PBAV in our hospital from 2014-12 to 2017-05 were studied. The baseline information, echocardiography parameters, peri-operative situation and follow-up condition were summarized. Results: All 15 AS patients were combined with severe HF including 3 with NYHA III and 12 with NYHA IV; 2 cases had cardiac shock. 6/15 patients received palliative PBAV for symptom relieving and 9 for bridging step (1 case pre-operative step for non-cardiogenic surgery). PBAV was successful in all patients; the average operative dilation was (2.60±1.3) times; 2 patients suffered from complete left bundle block at immediate post-operation, 1 had ventricular tachycardia during the operation and 1 had ischemic stroke 3 days after operation, no other complications occurred. Catheter measured immediate post-operative peak trans-valvular pressure gradient was decreased from (75.0±24.0) mmHg to (39.8±14.2) mmHg, P<0.01. Echocardiography showed that before discharge, the max flow velocity was reduced from (4.98±0.76) m/s to (4.20±0.75) m/s, P<0.01, max-PG reduced from(101.3±30.4) mmHg to (72.9.0±23.3) mmHg, P<0.01, mean-PG reduced from (62.4±19.0) mmHg to (44.9±15.1) mmHg, P<0.01;while left ventricular diastolic dimension and LVEF were similar at per- and post-operation, P>0.05. NT-proBNP was decreased from (13 889±12 303) pg/ml to (5 412±4 923) pg/ml, P<0.01. The average post-operative follow-up time was (3-27) months and the median NYHA grade improved from IV to II. Conclusion: Palliative and bridging PBAV was reliable and safe in severe AS-HF patients for short time, it had less complication and could be used as an optional treatment.