Immediate results and long‐term follow‐up after repeat balloon aortic valvuloplasty

AbstractBalloon aortic valvuloplasty (BAV) was performed in 219 elderly patients with aortic stenosis between December 1985 and April 1990. Forty‐three patients underwent repeat BAV for symptomatic restenosis of the aortic valve 13±8 mo following initial BAV. To evaluate the outcome following initial and repeat BAV, hemodynamic results were analyzed according to the following subgroups: BAV 1‐initial BAV for all patients (n = 219); BAV 1/1‐initial BAV in those who had only one BAV (n = 176); BAV 1/2‐the initial BAV in those who had repeat BAV (n = 43); and BAV 2‐repeat BAV (n = 43).The mean age of patients undergoing BAV 2 was 82±6 yr compared to 78±10 yr for all patients undergoing BAV 1 (p = .01). At the time of BAV 1 there was no difference in baseline or post‐valvuloplasty aortic valve area (AVA) or peak aortic valve gradient (AVG) for patients having BAV 1/1 compared to those having BAV 1/2. However, for patients having repeat BAV, although the magnitude of the hemodynamic improvement of BAV 1/2 (AVA increased from 0.6 to 0.9 cm2, AVG decreased from 65 to 34 mm Hg, p<.001) was similar to the magnitude of the hemodynamic improvement of BAV 2 (AVA increased from 0.5 to 0.8 cm2, AVG decreased from 65 to 34 mm Hg, p<.001), the baseline AVA (0.5 cm2 at BAV 2 vs. 0.6 at BAV 1/2) and the post‐valvuloplasty AVA (0.8 cm2 at BAV 2 vs. 0.9 at BAV 1/2) were significantly smaller (p<.004). There were no major complications in patients undergoing repeat BAV. Median event‐free survival was 12 mo after initial BAV and 8 mo after repeat BAV (p = .09).In conclusion, repeat BAV results in similar immediate hemodynamic improvement and event‐free survival compared to initial BAV. However, baseline aortic valve area and gradient prior to repeat BAV are significantly worse than those prior to initial BAV, suggesting that balloon‐induced injury to the aortic valve may offer only a temporary hiatus from the natural history of aortic stenosis.