Repeat balloon aortic valvuloplasty effectively delays surgical intervention in children with recurrent aortic stenosis

Petit, Christopher J.; Maskatia, Shiraz A.; Justino, Henri; Mattamal, Raphael; Crystal, Matthew A.; Ing, Frank F.

doi:10.1002/ccd.24562

Cited by 17 publications

(14 citation statements)

References 18 publications

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“…These findings are in line with the literature [1,6,9]. Nevertheless, a second intervention (either surgery or BAV-36 % in our series) appeared unavoidable in a third of patients in the long term [7,12,13]. The mortality rate was 11.8 % for the whole cohort and 27 % for the neonate subgroup.…”

Section: Discussionsupporting

confidence: 93%

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: Discussionsupporting

confidence: 93%

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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“…The results were comparable to surgical valvotomy (4). This was further correlated by Justino and the group at Texas Children’s Hospital who found that repeat AoVP effectively treats recurrent AS and postpones the need for surgical intervention (5). …”

Section: Discussionmentioning

confidence: 83%

Severe Aortic Stenosis and Severe Coarctation of the Aorta: A Hybrid Approach to Treatment

2017

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Hybrid surgery is becoming more popular in the treatment of children with congenital heart disease, particularly small infants and neonates. We report a case of a patient with aortic stenosis (AS) and coarctation of the aorta (CoA). Case: a 1-month-old baby presented with severe AS and CoA. The decision was made to perform a hybrid surgical procedure. The patient underwent a lateral thoracotomy for repair of the CoA and carotid cutdown for aortic balloon valvuloplasty (AoVP).

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“…that describes outcome of balloon dilatation after surgical valvotomy in 23 children. 23 They suggest that reintervention with balloon valvotomy is both effective in relieving stenosis and delays further surgical interventions. Our experience is that surgical valvotomy as primary treatment has definite advantages but, in this setting, balloon valvotomy may be a good option, as a less invasive procedure, for reintervention to postpone aortic valve replacement.…”

Section: Discussionmentioning

confidence: 99%

A national study of the outcome after treatment of critical aortic stenosis in the neonate

et al. 2020

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Objective: This study describes short-term and long-term outcome after treatment of critical valvular aortic stenosis in neonates in a national cohort, with surgical valvotomy as first choice intervention. Methods: All neonates in Sweden treated for critical aortic stenosis between 1994 and 2016 were included. Patient files were analysed and cross-checked against the Swedish National Population Registry as of December 2017, giving complete survival data. Diagnosis was confirmed by reviewing echo studies. Critical aortic stenosis was defined as valvular stenosis with duct-dependent systemic circulation or depressed left ventricular function. Primary outcome was all-cause mortality and secondary outcomes were reintervention and aortic valve replacement. Results: Sixty-one patients were identified (50 boys, 11 girls). Primary treatment was surgical valvotomy in 52 neonates and balloon valvotomy in 6. Median age at initial treatment was 5 days (0–26), and median follow-up time was 10.8 years (0.14–22.6). There was no 30-day mortality but four late deaths. Freedom from reintervention was 66%, 61%, 54%, 49%, and 46% at 1, 5, 10, 15, and 20 years, respectively. Median time to reintervention was 3.4 months (4 days to 17.3 years). Valve replacement was performed in 23 patients (38%). Conclusions: Surgical valvotomy is a safe and reliable treatment in these critically ill neonates, with no 30-day mortality and long-term survival of 93% in this national study. At 10 years of age, reintervention was performed in 54% and at end of follow-up 38% had had an aortic valve replacement.

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Repeat balloon aortic valvuloplasty effectively delays surgical intervention in children with recurrent aortic stenosis

Abstract: BAV2 is associated with decreased valve gradient, though with an increase in AI. However, residual AS, not AI, is associated with poor outcomes following BAV2. BAV2 effectively treats recurrent AS and postpones need for surgical intervention.

Cited by 17 publications

References 18 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

Severe Aortic Stenosis and Severe Coarctation of the Aorta: A Hybrid Approach to Treatment

A national study of the outcome after treatment of critical aortic stenosis in the neonate

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