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To study the long-term results of balloon aortic valvuloplasty (BAV) in a large cohort of patients with rheumatic valvular aortic stenosis. Balloon aortic valvuloplasty is proved as a palliative procedure as a bridge to TAVI and surgical AVR. We do not know the long-term outcomes of BAV in rheumatic etiology. We studied the outcomes of BAV in aortic stenosis of rheumatic origin and immediate and long-term data analyzed. The long term data is prudent as a majority of rheumatic patients are younger in age. We looked at the need for a surgical replacement among patients following BAV in rheumatic AS and survival following BAV.
Single center retrospective data analysis of immediate and long-term outcomes in patients following BAV from 2000 to 2009. One hundred and forty-four (144) patients with rheumatic aortic stenosis (AS) were studied who underwent BAV. Patients were divided into 3 groups for analysis following BAV. Successful BAV (more than 50% reduction in baseline gradient) (Group A), partially successful BAV (25-50% reduction in baseline gradient) and BAV failed <25% reduction in baseline gradient (Group C).
Mean age of patients was 21.7 years (95% CI 14.3–28.9) with a mean follow-up period of 5.7 years (± SD 1.3). 123 (85.9%)subjects were in Group A,12 (8.7%) subjects in Group B and 7 (5.4%) subjects in Group C. Concomitant balloon mitral valvuloplasty was done in 35/144 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) 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). 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 AR were noted in 50 (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. 5-year survival in isolated rheumatic AS following successful BAV (N=123) versus and surgical AVR (205) showed similar outcomes (P=0.632).
BAV is an effective treatment strategy in dominant AS in multivalvular rheumatic disease situations. Combined aortic and mitral valvuloplasty was performed in one-fourth of study patients. The need for surgery was much lower in Group A (2.5%) compared to Group B (50%) and C (100%). Five-year survival in isolated rheumatic AS following successful BAV showed similar outcomes with surgery.