Aortic stenosis surgery aortic valvuloplasty

Aortic Stenosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Aortic Stenosis from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Cardiac Stress Test
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography
Cardiac Catheterization
Aortic Valve Area
Aortic Valve Area Calculation
Treatment
General Approach
Medical Therapy
Surgery
Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty
Transcatheter Aortic Valve Replacement (TAVR) TAVR vs SAVR Critical Pathway Patient Selection Imaging Evaluation Valve Types TAVR Procedure Post TAVR management AHA/ACC Guideline Recommendations
Follow Up
Prevention
Precautions and Prophylaxis
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Aortic stenosis surgery aortic valvuloplasty On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Aortic stenosis surgery aortic valvuloplasty All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Aortic stenosis surgery aortic valvuloplasty
CDC on Aortic stenosis surgery aortic valvuloplasty
Aortic stenosis surgery aortic valvuloplasty in the news
Blogs on Aortic stenosis surgery aortic valvuloplasty
Directions to Hospitals Treating Aortic stenosis surgery aortic valvuloplasty
Risk calculators and risk factors for Aortic stenosis surgery aortic valvuloplasty

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editors-In-Chief: Claudia P. Hochberg, M.D. [2]; Abdul-Rahman Arabi, M.D. [3]; Keri Shafer, M.D. [4]; Priyamvada Singh, MBBS [[5]]

Assistant Editor-In-Chief: Kristin Feeney, B.S. [[6]]

Overview

Surgical intervention may be a necessary component of treatment. Intervention methods may include utilizing various techniques of aortic valvuloplasty.

Aortic valvuloplasty

Patient selection and treatment choices

• Surgical Aortic valve replacement is the treatment of choice for aortic stenosis but many patients are not good candidates due to advanced age and multiple co-morbidities
• Percutaneous aortic valve replacement is in its infancy and thus aortic valvuloplasty can offer palliation of symptoms and potentially prolong survival for these high risk patients in class III-IV heart failure
• It can be performed emergently in patients with end-stage heart failure due to aortic stenosis: patients in cardiogenic shock, as a bridge to aortic valve replacement, patients with critical aortic stenosis needing emergent non-cardiac surgery, poor surgical candidates and nonagenerians, patients with congenital or rheumatic aortic stenosis
• Results usually last 6 months up to 2 years (with repeat procedures possible if aortic regurgitation is not severe)
• Valvuloplasty tends to alleviate heart failure symptoms and improve hemodynamics but rarely does it alleviate angina

Technique

The retrograde technique is the most commonly used technique.

• 8 French femoral sheath can usually accommodate a 20 mm balloon and minimizes vascular complications
• Alternatively two 6 Fr sheath from bilateral femoral approach and two smaller balloons can be used
• The letter may be necessary in female elderly patients with concomitant peripheral vascular disease
• 0.035” straight wire is commonly used to cross the valve and advance via pig-tail or Amplatz catheter; Right heart catheterization is done and transaortic gradient is typically measured pre-procedure
• The 0.035” wire is then exchanged for a stiffer 0.038”Amplatz exchange length wire with the tip shaped into a pig-tail shape so as not to injure the LV
• The 20-23 mmX 6 cm balloon is advance over the wire and positioned to straddle the aortic valve
• The balloon is manually inflated with a 60 cc syringe containing diluted contrast (slowly)
• Meticulous control of balloon position must be maintained at all times by backward traction on the balloon to prevent jumping forward and injuring/perforating the LV apex