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Percutaneous balloon aortic valvotomy

Author
William H Gaasch, MD
Section Editors
Catherine M Otto, MD
Donald Cutlip, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

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 replacement (TAVR) 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, TAVR, 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 TAVR, 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 "Transcatheter aortic valve implantation: Indications and outcomes" and "Estimating the mortality risk of valvular surgery" and "Medical management of symptomatic aortic stenosis".)

MECHANISM

Percutaneous balloon aortic valvotomy is a procedure in which a balloon is placed across the stenotic aortic valve and inflated [3]. 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 [4].

OUTCOMES AND LIMITATIONS

There are a number of important limitations to the use of balloon aortic valvotomy:

     

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Literature review current through: Nov 2016. | This topic last updated: Mon Jan 05 00:00:00 GMT+00:00 2015.
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References
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