Efficacy of balloon valvuloplasty in patients with critical aortic stenosis and cardiogenic shock - The role of shock duration

Background: Because of limited long-term success, aortic balloon valvuloplasty is considered to be a palliative procedure, including patients at excessive risk for standard thera py-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 cm(2), from 0.38 +/- 0.09 to 0.81 +/- 0.12 cm(2), with an insignificant increase in cardiac index from 1.89 +/- 0.33 to 2.01 +/- 0.411/min m(2). 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 set-ting of cardiogenic shock and critical aortic stenosis, at the earliest possible convenience.