Balloon aortic valvuloplasty in neonates: short- and long-term effects and predictors of successful outcome

Abstract

Introduction: Balloon aortic valvuloplasty (BAV) is a common treatment method of aortic valve (AV) stenosis in neonates. Longterm BAV effects are suboptimal, and their predictors are not well acknowledged.Aim: To identify predictors of suboptimal short-and long-term BAV results.Material and methods: The study group comprised forty-three neonates (8 females; weight 3.34 ±0.56 kg) who underwent BAV between 1998 and 2021. Seventeen patients (39.53%) had critical AV stenosis. AV was bicuspid in 22 patients, tricuspid in 12, unicuspid in 2, and undefined in 7 patients. The mean balloon/annulus ratio was 0.9 ±0.07. Catheterization, clinical, and follow-up data were analysed.Results: The peak-to-peak gradient decreased from 67.5 ±26.3 to 21.3 ±12.6 mm Hg. Twenty-eight patients (65.1%) had adequate early outcome. Aortic regurgitation (AR) occurred in 13 (30.2%) patients. No predictors of inadequate early outcome were found. Twenty-year survival was 90.7%. Eleven (35.5%) patients underwent reintervention at a median of 12 (1-215) months; BAV in 5 patients, surgical valvuloplasty in 2, Ross operation in 2, AV replacement in 1, and Norwood operation in 1 patient. Fifteen-year freedom from reintervention (FFR) was 48%. Adequate early outcome resulted in higher FFR (71% vs. 22%), and so did no significant AR (60% vs. 30%).Conclusions: BAV provides satisfying early results. AR remains a significant aftermath of BAV. Risk factors and procedural techniques improving the outcome of BAV are unclear. Further research is needed to improve FFR.

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

“…Among others, severe left ventricular dysfunction is a risk factor for AV surgery following neonatal BAV, according to Kido et al [31]. However, the time gained until the first surgery is worthwhile because patients with congenital AV stenosis are exposed to a high mortality risk for multiple AV operations, including AV reconstruction, the Ross procedure, or AV prosthesis [32][33][34][35][36]. Thus, future perioperative risks due to typical intrathoracic adhesions [37,38] might be reduced by postponing surgery to later childhood.…”

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

“…Among others, severe left ventricular dysfunction is a risk factor for AV surgery following neonatal BAV according to Kido et al [25]. However, the gain of time until first surgery is worthwhile because patients with congenital AV stenosis are exposed to a high life-time risk for multiple AV operations including AV reconstruction, Ross procedure or AV prosthesis [26][27][28][29][30]. Thus, future perioperative risks due to typical intrathoracic adhesions [31,32] might be reduced by postponing surgery to later childhood.…”