Percutaneous balloon aortic valvotomy
- William H Gaasch, MD
William H Gaasch, MD
- Section Editor — Valvular Disease
- Professor of Medicine
- University of Massachusetts Medical School
- Tufts University School of Medicine
- Senior Consultant in Cardiology
- Lahey Clinic
- Section Editors
- Catherine M Otto, MD
Catherine M Otto, MD
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Cardiac Evaluation; Valvular Disease
- Professor of Medicine
- University of Washington
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
Aortic valve replacement (AVR) is the mainstay of treatment of symptomatic severe aortic stenosis (AS) as it offers substantial improvements in symptoms and life expectancy. However, aortic valve surgery entails substantial risks for some patients with severe comorbidities, and for some considered at "extreme" risk, surgery is not appropriate. In others, technical limitations (eg, porcelain aorta) may mean that surgery is not feasible.
Percutaneous balloon aortic valvotomy (also known as balloon aortic valvuloplasty) was developed as a less invasive means to treat severe AS but has limited utility and substantial risks. Subsequently developed, transcatheter aortic valve implantation (TAVI) is an alternative method for treating severe AS in selected patients with unacceptably high estimated surgical risks. A multidisciplinary team approach is recommended in approaching patients with symptomatic AS and choosing between surgical AVR, TAVI, and medical therapy, with possible use of percutaneous balloon aortic valvotomy [1,2].
This topic will review percutaneous balloon aortic valvotomy in adults. Indications for AVR, considerations for surgical AVR and TAVI, estimating the risk of aortic valve surgery, and medical therapy of symptomatic AS are discussed separately. (See "Indications for valve replacement in aortic stenosis in adults" and "Choice of prosthetic heart valve for surgical replacement" and "Choice of therapy for symptomatic severe aortic stenosis" and "Estimating the mortality risk of valvular surgery" and "Medical management of symptomatic aortic stenosis".)
Percutaneous balloon aortic valvotomy is a procedure in which a catheter-based balloon is placed across the stenotic aortic valve and inflated . The aim is to relieve the stenosis by fracturing calcific deposits within the valve leaflets. Stretching of the annulus and separation of the calcified commissures may also contribute to valve opening, though the effects of valvotomy have not been fully elucidated .
OUTCOMES AND LIMITATIONS
There are a number of important limitations to the use of balloon aortic valvotomy:
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