For similar reasons balloon aortic valvoplasty is
the treatment of choice in patients with valvar aortic stenosis and
can be performed with low mortality, good relief of aortic obstruction,
and variable but usually mild aortic insufficiency. Patients with
calcific aortic stenosis, moderate to severe aortic insufficiency,
or annular hypoplasia are not good candidates for valvoplasty. Early
and medium-length follow-up studies show results comparable to primary
surgery; usually there is less aortic regurgitation but occasionally
severe aortic regurgitation necessitates valve replacement. Longer-term
studies suggest the durability or repair with balloon dilatation
may be less than that with surgery. The risks of valvoplasty include
arrhythmias, emboli, neurologic events, and injury to access vessels.
In contrast, surgical risks include mortality, risks of anesthesia,
cardiopulmonary bypass, blood products, the disadvantages of a long
hospitalization, an undesirable scar, and greater cost. Both balloon
aortic valvoplasty and surgical valvotomy are palliative. Longer-term
follow-up suggests that repeat treatment for either recurrent stenosis or
worsening insufficiency occurs in 50% of patients within
8 years of valvoplasty. In some patients who develop restenosis
after surgical or balloon procedures, balloon valvoplasty has been
used as a means of deferring valve replacement; such delays are
particularly important in small children who would otherwise require
multiple valve replacements.