Balloon aortic valvotomy through a carotid cutdown in infants with severe aortic stenosis: results of the multi-centric registry

Bv, Robinson; Brzezińska‐Rajszys, Grażyna; Hs, Weber; Ksiazyk, J; Fj, Fricker; Dr, Fischer; Ja, Ettedgui

doi:10.1017/s104795110000915x

Cited by 51 publications

(38 citation statements)

References 22 publications

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“…6 A multicenter study assessing outcomes after carotid cutdown in infants found that 12% had abnormalities-ranging from stenosis to complete occlusion-after surgical carotid cutdown and repair, although follow-up imaging was only available in two thirds of patients. 5 The lack of consistent follow-up carotid imaging in most reports of surgical cutdown, therefore, renders direct comparison with carotid patency rates with our PCA cohort difficult. Furthermore, the miniaturization of sheaths and balloon catheters over time could bias older reports of carotid cutdown toward lower carotid patency rates because of the larger sheath sizes that were previously required.…”

Section: Discussionmentioning

confidence: 96%

“…1 As first described in children by Azzolina et al 2 in 1973, surgical carotid cutdown involved placement of a purse-string suture, followed by creation of a longitudinal arteriotomy through which catheters were placed, and tying of the purse-string suture at the end of the case. Although this approach has been widely used and is considered to be safe and effective, [3][4][5][6] it is invasive, time consuming, requires an available surgeon, and results in scarring that is cosmetically less appealing and could complicate repeat vascular access in the same vessel.…”

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confidence: 99%

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Percutaneous Common Carotid Artery Access for Pediatric Interventional Cardiac Catheterization

Justino

Petit

2016

Circ: Cardiovascular Interventions

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Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

Percutaneous Common Carotid Artery Access for Pediatric Interventional Cardiac Catheterization

Justino

Petit

2016

Circ: Cardiovascular Interventions

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“…Various independent risk factors for valvoplasty outcome identified by the logistic regression have already been reported. In newborns, 21 the risk factors for death were mitral stenosis, short left ventricle, and aortic annulus diameter , 6 mm. In patients 6 weeks to 20 years old, 5 the risk factor for early restenosis was age , 3 years.…”

Section: Discussionmentioning

confidence: 99%

Long term results of percutaneous balloon valvoplasty of congenital aortic stenosis: independent predictors of outcome

Reich

Tax²,

Marek³

et al. 2004

Heart

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Objective: To evaluate long term results and independent predictors of outcome of aortic valvoplasty. Design: Retrospective follow up study. Independent predictors of outcome identified by multiple logistic regression. Setting: Tertiary referral centre. Patients: 269 consecutive patients treated at the median age of 8 months (0-23 years): 80 (30%) under 4 weeks, 59 (22%) between 4 weeks and 1 year, and 130 (48%) over 1 year. The follow up period was up to 14.8 years (median 5.3, in survivors 6.4 years). Interventions: Percutaneous balloon valvoplasty with mean (SD) balloon to annulus ratio 0.97 (0.08). Main outcome measures: Restenosis > 70 mm Hg, grade 3 aortic insufficiency, cusps disruption, surgery, death, and valvoplasty failure (significant restenosis or insufficiency or surgery or death). Results: The mortality rate was 10.4% (n = 28), the restenosis rate was 16.7% (n = 45), significant insufficiency developed in 22.3% (n = 60), surgery was needed in 20.1% (n = 54), and ''valvoplasty failure'' occurred in 41.6% (n = 112) patients. Mean (SEM) survival probability 14.4 years after the procedure was 0.89 (0.02) and mean (SEM) probability of surgery-free survival was 0.50 (0.08). The independent predictors were as follows. For restenosis: small aortic annulus; for cusp disruption: large aortic annulus; for insufficiency: bicuspid aortic valve; for need for surgery: bicuspid aortic valve; for death: small aortic annulus, low left ventricular shortening fraction, and low sequential number of the valvoplasty; and for valvoplasty failure: small aortic annulus, bicuspid aortic valve, and high grade of mitral insufficiency. Conclusion: Independent predictors of unfavourable outcome are small aortic annulus, bicuspid aortic valve, poor function of left ventricle or mitral valve, and limited operator experience. P ercutaneous balloon valvoplasty was first described in 1983.1 The effectiveness of the method in gradient reduction and the low incidence of restenosis shortly after the procedure were documented in children with congenital aortic stenosis. 2In 1986, the first balloon valvoplasty was performed in a newborn with critical aortic stenosis.3 Good short term results were obtained in a large cohort of children in a multicentre study. 4 Mid-term results, however, showed a substantial incidence of restenosis, severe aortic insufficiency, and reinterventions.5 6 Long term results have so far been published only for children treated after 1 year of age with a 20% restenosis rate and a 21% incidence of significant aortic insufficiency 2-12 years after the procedure.

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“…It is worth noting that the performance of the procedure by our team in a preterm neonate weighing 1.1 kg in 40 minutes resulted in no complications. The multicenter experience shows that the results of aortic valvuloplasty through the carotid route in young infants (< 6 months of age) are very good, with high success indices and low complication rates in patients with no risk factors 20 . Imaging studies show that carotid permeability is maintained in more than 95% of the patients and that neurological complications are exceptional 20 .…”

Section: Discussionmentioning

confidence: 99%

Short- and midterm follow-up results of valvuloplasty with balloon catheter for congenital aortic stenosis

Pedra¹,

Pedra²,

Braga³

et al. 2003

Arq. Bras. Cardiol.

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Original ArticleAortic stenosis accounts for 5-6% of the congenital heart diseases and clearly predominates in the male sex 1 . The presence of commissural fusion with a variable thickening and a reduction in the mobility of the valvular leaflets are almost constant anatomic findings 1 . Association with a bicuspid valve is also frequent 1 . Longitudinal studies about the natural history of the disease suggest that the intervention is indicated in the presence of severe stenosis, which is defined by clinical, electrocardiographic, and hemodynamic findings 2 . Surgical valvulotomy has always been the classic therapeutic method considered the gold standard. With the evolution of interventional techniques from the mid 1980s onwards, balloon valvuloplasty started to be used in the initial treatment of aortic stenosis in different age groups with satisfactory short-and midterm results . We report the experience of the teams at the Instituto Dante Pazzanese and the Hospital do Coração with this type of approach. MethodsValvuloplasty was performed in conditions of severe stenosis, classically defined by the presence of a peak-topeak systolic gradient 30,31 detected in the catheterization room or derived from echocardiography 32,33 > 70 mmHg, or, when electrocardiographic alterations (of the T wave or ST segment) or clinical symptoms (dizziness and syncope with no other causes; significant chest pain) were present, a peak-to-peak systolic gradient > 50 mmHg. The procedure was also performed in neonates or young infants (between 1 and 6 months of age) with aortic stenosis and severe ventricular dysfunction, independent of the transvalvular gradient, because in that situation that gradient is underestimated due to the low systemic cardiac output. Valvuloplasty was contraindicated in the presence of moderate and severe aortic regurgitation, of other associated intracardiac lesions requiring immediate surgery, and of a hypoplastic left ventricle requiring palliative surgery, within a therapeutic Objective -To report short and midtem follow-up results of balloon aortic valvuloplasty to treat congenital aortic stenosis. Methods -

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Balloon aortic valvotomy through a carotid cutdown in infants with severe aortic stenosis: results of the multi-centric registry

Cited by 51 publications

References 22 publications

Percutaneous Common Carotid Artery Access for Pediatric Interventional Cardiac Catheterization

Percutaneous Common Carotid Artery Access for Pediatric Interventional Cardiac Catheterization

Long term results of percutaneous balloon valvoplasty of congenital aortic stenosis: independent predictors of outcome

Short- and midterm follow-up results of valvuloplasty with balloon catheter for congenital aortic stenosis

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