Circulation, Vol 89, 642-650, Copyright © 1994 by American Heart Association
CM Otto, MC Mickel, JW Kennedy, EL Alderman, TM Bashore, PC Block, JA Brinker, D Diver, J Ferguson and DR Holmes Jr
BACKGROUND: To identify predictors of long-term outcome after balloon
aortic valvuloplasty, we analyzed data on 674 adults (mean age, 78 +/- 9
years; 56% were women) undergoing this procedure at 24 clinical centers who
had a mean initial increase in aortic valve area of 0.3 cm2. METHODS AND
RESULTS: Baseline data included clinical, echocardiographic, and
catheterization variables. Follow-up data included mortality, cause of
death, rehospitalization, 6-month echocardiography, and functional status.
Kaplan-Meier curves and log- rank tests were used to evaluate survival in
subgroups. Multivariate Cox regression models were used to identify
independent predictors of survival. Overall survival was 55% at 1 year, 35%
at 2 years, and 23% at 3 years, with the majority of deaths (70%)
classified as cardiac by an independent review committee. Rehospitalization
was common (64%), although 61% of survivors at 2 years reported improved
symptoms. Echocardiography at 6 months (n = 115) showed restenosis from the
postprocedural valve area of 0.78 +/- 0.31 cm2 to 0.65 +/- 0.25 cm2 (P <
.0001). With stepwise multivariate analysis, sequentially adding clinical,
echocardiographic, and catheterization variables, the overall model
identified independent predictors of survival as baseline functional
status, baseline cardiac output, renal function, cachexia, female gender,
left ventricular systolic function, and mitral regurgitation. Baseline and
postprocedural variables were examined to identify which subgroup of
patients has the best outcome after aortic valvuloplasty. A "lower-risk"
subgroup (28% of the study population), defined by normal left ventricular
systolic function and mild clinical functional limitation, had a 3-year
survival of 36% compared with 17% in the remainder of the study group.
CONCLUSIONS: Long-term survival after balloon aortic valvuloplasty is poor
with 1- and 3-year survival rates of 55% and 23%, respectively. Although
survivors report fewer symptoms, early restenosis and recurrent
hospitalization are common.
ARTICLES
Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis
Balloon Valvuloplasty Coordinating Center, University of Washington, Seattle 98195.
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