A Comparison of Anterograde Versus Retrograde Approaches for Neonatal Balloon Aortic Valvuloplasty

Abstract

In neonates requiring balloon aortic valvuloplasty, both anterograde and retrograde approaches are feasible. A recent comparison of these two approaches is lacking. A retrospective cohort study of neonates at a single center undergoing BAV from 9/00 to 7/14 was performed. Records were reviewed including pre- and post-intervention echocardiograms and catheterization data. Comparisons of acute efficacy and procedural safety were made based on type of approach utilized. Forty-two neonates underwent BAV. Eleven cases utilized exclusively an anterograde approach, while 31 included a retrograde approach (including 4 with both approaches used). There were no significant differences between groups in baseline demographic and clinical characteristics. Additionally, by both pre-intervention echocardiogram and catheterization, there were no differences based on approach in aortic valve gradient, degree of aortic insufficiency (AI), or degree of mitral regurgitation (MR). Both approaches were equally efficacious in gradient reduction (45 ± 17 vs. 44 ± 21 mmHg, p = 0.97), and there was no difference in post-intervention AI as assessed by both catheterization and echocardiogram (52% vs. 64% none or trivial, p = 0.74). Additionally, there was no difference in the proportion of patients with an increased severity of MR after BAV (15% vs. 22%, p = 0.52). The retrograde approach required a larger arterial catheter and was associated with a higher rate of arterial thrombosis (61% vs. 18%, p = 0.014). Both anterograde and retrograde approaches to neonatal BAV appear to be equally efficacious in the short term. The anterograde approach avoids the need for a larger arterial catheter and may reduce the risk of arterial thrombosis.

Balloon Valvuloplasty In Congenital Critical Aortic Valve Stenosis – A Rescue Procedure For The Left Ventricle

“…For this purpose, it is useful to fixate the guiding wire in the descending aorta using a retrieval loop as first described by Rao et al [37] in a trans-umbilical approach. The antegrade approach is associated with mitral valve injury whereas there is risk for arterial thrombosis in retrograde catheterization [36,38]. Both did not occur in our population.…”

“…We describe a technique to provide more support for the angiographic catheter by inserting it via guide wire and an additional microcatheter. If a retrograde approach is unfeasible, trans-venous antegrade catheterization should be considered which provides equally effective results [36]. Here, a stable and safe positioning of the balloon during BAV can be technically delicate.…”

Balloon Valvuloplasty in Congenital Critical Aortic Valve Stenosis in Neonates and Infants: A Rescue Procedure for the Left Ventricle

“…The antegrade approach is associated with mitral valve injury, whereas there is a risk of arterial thrombosis in retrograde catheterization [42,44]. Neither occurred in our population.…”

“…In principle, either transarterial retrograde or trans-venous antegrade catheterization is possible. If a retrograde approach is unfeasible due to severely dysplastic and stenotic aortic valves featuring tiny orifice areas as well as systolic counter flow, then trans-venous antegrade catheterization should be considered, which provides equally effective results [42]. Here, stable and safe positioning of the balloon during BAV can be technically delicate.…”

Bicuspid Aortic Valve in Children and Adolescents: A Comprehensive Review

“…Balloon aortic valvuloplasty can be performed by an “anterograde” approach via the femoral vein reaching the aortic valve through an atrial septal defect or, more usually, by a “retrograde” one, via the femoral artery or carotid or brachial artery [ 48 ]. The main complication of the procedure is represented by secondary AR; because the risk is increased when oversized balloons are used [ 49 ], the balloon catheter is chosen to obtain a balloon/annulus ratio less than 0.9.…”