Aortic Valvuloplasty in Pediatric Patients Substantially Postpones the Need for Aortic Valve Surgery

Abstract

Background-Aortic valvuloplasty (AoVP) is an established procedure regarded as a valid alternative for surgical management of congenital aortic valve stenosis. However, its long-term efficacy in preventing or postponing aortic valve surgery remains uncertain for the individual patient. Therefore, the aim of this study was to study the long-term results of AoVP in pediatric patients and its efficacy in preventing or postponing aortic valve surgery. Methods and Results-We reviewed up to 17.5 years of follow-up data of all 188 patients who received AoVP at the Deutsches Herzzentrum München. The patients were divided into those Ͻ1 month of age (group Ͻ1 month; nϭ68) and those Ն1 month of age (group Ն1 month; nϭ120) at the time of AoVP. After the first and second AoVP, moderate and severe aortic regurgitation developed in 29% and 14%, respectively, of the patients in group Ͻ1 month and in 19% and 29%, respectively, of the patients in group Ն1 month. Survival after 10 years free from aortic valve surgery was 59% (95% confidence interval, 45 to 73) in group Ͻ1 month and 70% (95% confidence interval, 59 to 81) in group Ն1 month. Conclusions-This

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“…Embolizasyon riskini azaltmak için uygun boyutta cihaz kullanılması önerilmektedir (62)(63)(64)(65). Cihaz protrüzyonuna bağlı inen aortada obstrüksiyon ve sol pulmoner arter (LPA) darlığı transkateter yolla PDA oklüzyonunda % 0-1.7 oranında görülebilen komplikasyonlardır (38,(66)(67)(68).…”

Congenital Aortic Stenosis in Childhood

“…In a very recent series, including both neonates and older children, 10% of the patients needed reintervention in the long term due to restenosis (Fratz et al, 2008). The survival rate after valvoplasty at 6 and 14.4 years varies between 93% and 100% in older children (Fratz et al, 2008;Galal et al, 1997;Moore et al, 1996;Reich et al, 2004), whereas it varies between 71-74.6% (Fratz et al, 2008;McElhinney et al, 2005) and 71% (Reich et al, 2004) at 10 and 14.4 years respectively when performed in the neonatal period. The freedom from reintervention at mid and longterm follow up varies between 46 and 76% (Fratz et al, 2008;Galal et al, 1997;Moore et al, 1996;Rao, 1999;Reich et al, 2004) after 8-14.4 years in older children, whereas it varies between 47-57.6% (Fratz et al, 2008;McElhinney et al, 2005;Villalba et al, 2002) and 26% (Reich et al, 2004) at 5-10 years and 14.4 years respectively when performed in the neonatal period.…”

“…This iatrogenic regurgitation, which was described to be associated with fused bicuspid valves (Reich et al, 2004), has been proven to be related to oversized balloons which lead to improve practice and guidelines, therefore high degrees of immediate post procedural insufficiency became uncommon (McCrindle et al, 1996;Phillips et al, 1987;Sholler et al, 1988). The rate of at least moderate aortic regurgitation shortly after the procedure is between 7.3-22.6% and may progress afterwards (Crespo et al, 2009;Fratz et al, 2008;McCrindle et al, 1996;McElhinney et al, 2005;Reich et al, 2004). Iatrogenic aortic insufficiency, severe hypotension, ventricular arrhythmias, vessel damage, complete atrioventricular block, cardiac tamponade and mitral valve injury are the main serious procedural related complications.…”

“…The increase in residual transvalvar gradient, or restenosis, varies between 0% and 32.1% according to different definitions of residual gradients used by different investigators (Balmer et al, 2004;Rao et al, 1989;Reich et al, 2004). In a very recent series, including both neonates and older children, 10% of the patients needed reintervention in the long term due to restenosis (Fratz et al, 2008). The survival rate after valvoplasty at 6 and 14.4 years varies between 93% and 100% in older children (Fratz et al, 2008;Galal et al, 1997;Moore et al, 1996;Reich et al, 2004), whereas it varies between 71-74.6% (Fratz et al, 2008;McElhinney et al, 2005) and 71% (Reich et al, 2004) at 10 and 14.4 years respectively when performed in the neonatal period.…”

Management of Congenital Aortic Stenosis by Catheter Techniques

“…Intermediate and long term results of aortic valvuloplasty of congenital aortic valve stenosis in preventing or postponing aortic valve surgery are very good (Fratz et al, 2008). Survival after successful balloon valvuloplasty without significant residual stenosis or regurgitation has been reported to be 86% at 1 year and continues to remain the same until 10 years (Han et al, 2007).…”