Search this site:

MARCH 2001:    Contents    Previous   Next

Clin. Cardiol. 24, 214–218 (2001)

Efficacy of Balloon Valvuloplasty in Patients with Critical Aortic Stenosis and Cardiogenic Shock--The Role of Shock Duration

Arnd B. Buchwald, M.D., Thomas Meyer, M.D., Karlheinz Scholz, M.D., Bernd Schorn, M.D.,* Christina Unterberg, M.D.

Departments of Cardiology and *Cardiothoracic Surgery, University Clinic Göttingen, Göttingen, Germany

Summary

Background: Because of limited long-term success, aortic balloon valvuloplasty is considered to be a palliative procedure, including patients at excessive risk for standard therapy--aortic valve replacement--that is, those in cardiogenic shock.

Hypothesis: The study was undertaken to evaluate the outcome of balloon valvuloplasty for critical aortic stenosis complicated by cardiogenic shock.

Methods: Over a 10-year-period, we followed 14 patients (age 74 ± 11 years, range 50–91) presenting in cardiogenic shock and critical aortic stenosis, who underwent valvuloplasty, together with 19 patients with critical aortic stenosis requiring urgent major noncardiac surgery.

Results: In patients in shock, calculated aortic valve area could be increased successfully by at least 0.3 cm2, from 0.38 ± 0.09 to 0.81 ± 0.12 cm2, with an insignificant increase in cardiac index from 1.89 ± 0.33 to 2.01 ± 0.41 l / min * m2. In-hospital mortality was 71% (10 patients). Two patients underwent valve replacement within 16 days and survived after 1 year, as did two patients refusing surgery. By multivariate logistic regression analysis, only an interval between onset of shock symptoms and valvuloplasty of >48 h was significantly associated with fatal outcome (p<0.01). In those patients requiring noncardiac surgery, this was possible after valvuloplasty in 95% who survived 1 year after hospital discharge. One patient in this group died of pulmonary embolism the day after the procedure.

Conclusion: These data support the concept of causal treatment in patients with cardiogenic shock, as well as in the setting of cardiogenic shock and critical aortic stenosis, at the earliest possible convenience.

Key words: aortic valve stenosis, shock, valvuloplasty

Address for reprints:
Arnd B. Buchwald, M.D.
Zentrum Innere Medizin
Abteilung Kardiologie und Pneumologie
Universitätsklinik
Robert-Koch-Str. 40
37075 Göttingen, Germany

Received: January 14, 2000
Accepted with revision: May 12, 2000


MARCH 2001:    Contents    Previous   Next