Aortic stenosis surgery aortic valvuloplasty
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Aortic Stenosis Microchapters |
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Diagnosis |
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Treatment |
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Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty |
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Transcatheter Aortic Valve Replacement (TAVR) |
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Case Studies |
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Aortic stenosis surgery aortic valvuloplasty On the Web |
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American Roentgen Ray Society Images of Aortic stenosis surgery aortic valvuloplasty |
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Directions to Hospitals Treating Aortic stenosis surgery aortic valvuloplasty |
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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: Mohammed A. Sbeih, M.D.[2]; Claudia P. Hochberg, M.D. [3]; Abdul-Rahman Arabi, M.D. [4]; Keri Shafer, M.D. [5]; Priyamvada Singh, MBBS [[6]]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [[7]]
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