Balloon aortic valvuloplasty in elderly patients: a review and update

摘要

Calcific aortic stenosis (AS) is the most common valvular heart disease in the western world, with moderate-to-severe stenosis in approximately 3% of adults >75 years in the USA and Europe [1-3]. Severe, symptomatic AS cannot be treated medically. Medical management offers no therapy to prolong life and there are limited treatments to reduce symptoms in patients with severe AS [4]. Medical management is generally only used when severe comorbidity or patient preference precludes surgical or other invasive options. Definitive treatment of calcific AS is surgical valvular replacement [5]. Due to the elderly age of the typical AS population and frequent comorbidities, surgical options are often limited in patients with severe AS. Transcatheter aortic valve implantation (TAVI) may be considered for patients with severe, symptomatic AS who are not surgical candidates [6-io]. TAVI may be better tolerated than aortic valve replacement (AVR), with similar long-term survival. Balloon aortic valvuloplasty (BAV) often forms an integral part of TAVI treatment and is typically used as a bridge to definitive treatment or for symptomatic palliation. Since BAV has generally been linked with short-term benefits without long-term improvement in disease prognosis, it is generally not considered a definitive treatment for most adults with severe AS [li]. The purpose of this review is to explore current data on outcomes after AS treatment, with special attention to an expanded role for BAV in very elderly patients.