Background
Optimal initial treatment for congenital aortic valve stenosis in children remains unclear between balloon aortic valvuloplasty (
BAV
) and surgical aortic valvotomy (
SAV
).
Methods and Results
We performed a contemporary systematic review and meta‐analysis to compare survival in children with congenital aortic valve stenosis. Secondary outcomes included frequency of at least moderate regurgitation at hospital discharge as well as rates of aortic valve replacement and reintervention. Single‐ and dual‐arm studies were identified by a search of PubMed (Medline), Embase, and the Cochrane database. Overall 2368 patients from 20 studies were included in the analysis, including 1835 (77%) in the
BAV
group and 533 (23%) in the
SAV
group. There was no difference between
SAV
and
BAV
in hospital mortality (
OR
=0.98, 95%
CI
0.5–2.0,
P
=0.27, I
2
=22%) or frequency of at least moderate aortic regurgitation at discharge (
OR
=0.58, 95%
CI
0.3–1.3,
P
=0.09, I
2
=54%). Kaplan–Meier analysis showed no difference in long‐term survival or freedom from aortic valve replacement but significantly more reintervention in the
BAV
group (10‐year freedom from reintervention of 46% [95%
CI
40–52] for
BAV
versus 73% [95%
CI
68–77] for
SAV
,
P
<0.001). Results were unchanged in a sensitivity analysis restricted to infants (<1 year of age).
Conclusions
Although higher rates of reintervention suggest improved outcomes with
SAV
, indications for reintervention may vary depending on initial intervention. When considering the benefits of a less‐invasive approach, and clinical equipoise with respect to more clinically relevant outcomes, these findings support the need for a randomized controlled trial.