Neonatal balloon aortic valvuloplasty—predictive value of current risk score algorithms for treatment strategies

Eicken, Andreas; Georgiev, Stanimir; Balling, Gunter; Schreiber, Christian; Hager, Alfred; Hess, John

doi:10.1002/ccd.22363

Cited by 21 publications

(8 citation statements)

References 28 publications

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“…The causes of death were multifactorial: In four cases, death was considered secondary to BAV complications, and in eight cases (8/11-72 %), patients were finally diagnosed with a ''borderline LV'' with abnormal left heart structures or non-compliant LV, clearly associated with an increased risk of poor results and death [14]. When neonates are diagnosed with a ''borderline LV,'' predicting which is suitable for biventricular repair remains a substantial challenge [2,5,11] and the presence of endocardial fibroelastosis with LV diastolic dysfunction appears to be a more significant risk factor than LV volume or dimensions [14]. LV systolic dysfunction preceding BAV also tended to be associated with poor survival.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results of Balloon Valvuloplasty as Primary Treatment for Congenital Aortic Valve Stenosis: a 20-Year Review

et al. 2015

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In the presence of new surgical techniques, the treatment of congenital valvular aortic stenosis is under debate. We reviewed the results and late outcomes of all 93 patients aged 1 day to 18 years, treated with balloon valvuloplasty (BAV) as first-line therapy for congenital aortic valve stenosis in our center from January 1991 to May 2012. Mean age at procedure time was 2.4 years; 37 patients underwent BAV at age ≤30 days (neonates), 29 patients at age ≥1 month and <1 year (infants), and 27 patients were older than 1 year (children). The invasive BAV peak-to-peak aortic valve gradient (mean 59 ± 22 mmHg) was immediately reduced (mean 24 ± 12 mmHg). The observed diminution of gradient was similar for each age group. Four patients had significant post-BAV AI. Mean follow-up after BAV was 11.4 ± 7 years. The last echo peak aortic gradient was 37 ± 18 mmHg and mean gradient was 23 ± 10 mmHg, and two patients had significant AI. Actuarial survival for the whole cohort was 88.2 and 72.9 % for the neonates. All infants, except one, and all children survived. Sixty-six percent of patients were free from surgery, and 58 % were free from any reintervention, with no difference according to age. Freedom from surgery after BAV at 5, 10, and 20 years, respectively, was 82, 72, and 66 %. Our study confirms that BAV as primary treatment for congenital AS is an efficient and low-risk procedure in infants and children. In neonates, the prognosis is more severe and clearly related to "borderline LV."

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Section: Discussionmentioning

confidence: 99%

Long-Term Results of Balloon Valvuloplasty as Primary Treatment for Congenital Aortic Valve Stenosis: a 20-Year Review

et al. 2015

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“…Aortic regurgitation may occur after aortic balloon valvuloplasty (AoVP) in patients with borderline left ventricle. 5 Aortic regurgitation after AoVP is a known risk factor for a subsequent Norwood operation. 6 In fact, in this old publication, severe aortic regurgitation was a contra indication for a Norwood operation.…”

Section: Discussionmentioning

confidence: 99%

Early postoperative interventional aortic valve closure for severe aortic regurgitation in a neonate after Norwood procedure

2019

Self Cite

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A neonate presented with signs of heart failure early after a Norwood procedure, due to increase of aortic and mitral valve regurgitation. Because repeated surgery was considered risky, we closed the aortic valve by catheter intervention with an Amplatzer Duct Occluder. Aortic regurgitation was abolished almost completely and the child improved. Unfortunately, 2 weeks after discharge, the patient died suddenly.

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“…Our study, in line with the findings achieved by other authors, confirmed good effec tiveness of BAV in reducing PG across the aor tic valve directly after the procedure in all age groups. 4,5,[10][11][12][13][14][15][16] The severity of AR assessed direct ly after the procedure was mostly moderate in 98.5% of patients and severe only in 1 patient. The published studies reported severe AR di rectly after the procedure at rates ranging from 0% to 40%, depending on the grading scale (a 3 or 4point scale), assessment method (angio graphic or echocardiographic), definition of se vere AR (grade ≥2 or grade ≥3), and timing of the procedures.…”

Section: What's New?mentioning

confidence: 98%

Long-term results of percutaneous balloon aortic valvuloplasty in children with aortic stenosis: a single-center experience

Godlewski

Werner

2020

Kardiol Pol

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BACKGROUND Percutaneous balloon aortic valvuloplasty (BAV) is an effective method of treatment for aortic stenosis in children. AIMS This study aimed to assess the long-term results of BAV in various age groups in the pediatric population. METHODS This retrospective study included 68 patients (newborns, infants, and children older than 1 year). We analyzed their demographic data and measurements performed with the use of cardiac catheterization, angiography, and echocardiography at 3 time points: before, directly after, and at late follow-up after BAV, including the invasive aortic valve peak-to-peak systolic pressure gradient (PG peak), maximum systolic pressure gradient (PG max) by Doppler echocardiography, and the severity of aortic regurgitation (AR). Long-term follow-up data were available for 57 patients. RESULTS The BAV procedure led to a significant reduction in the PG peak values. Late follow-up revealed a progression of AR. Aortic regurgitation of grade 2 or higher directly after BAV was the strongest risk factor for severe AR at late follow-up. After 5, 10, and 18 years after BAV, surgical treatment was not required in 90%, 77%, and 59.5% of patients, respectively. Severe AR and a residual PG less than 35 mm Hg at late follow-up were stronger risk factors for aortic valve surgery than moderate AR and PG higher than or equal to 35 mm Hg. CONCLUSIONS Balloon aortic valvuloplasty is an effective method of treatment for aortic stenosis in children, which delays the need for surgery. The progression of AR occurs at late follow-up. A greater reduction in PG max is a risk factor for at least moderate AR directly after BAV, which results in the progression of AR at late follow-up.

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Neonatal balloon aortic valvuloplasty—predictive value of current risk score algorithms for treatment strategies

Abstract: No prospectively tested criteria for patient selection (biventricular vs. univentricular) are available for critically ill newborns with AoS. Retrospective application of the current risk scores showed unsatisfactory results. Treatment decisions are based on local experience and expertise.

Cited by 21 publications

References 28 publications

Long-Term Results of Balloon Valvuloplasty as Primary Treatment for Congenital Aortic Valve Stenosis: a 20-Year Review

Long-Term Results of Balloon Valvuloplasty as Primary Treatment for Congenital Aortic Valve Stenosis: a 20-Year Review

Early postoperative interventional aortic valve closure for severe aortic regurgitation in a neonate after Norwood procedure

Long-term results of percutaneous balloon aortic valvuloplasty in children with aortic stenosis: a single-center experience

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