Results of balloon dilatation of stenotic homografts in pulmonary position in children and young adults

Abstract

Balloon dilatation is able to reduce the peak systolic pressure gradient over homografts in a subgroup of patients and can be of clinical significance to postpone re-intervention or pulmonary valve replacement.

How Long Can the Next Intervention Be Delayed after Balloon Dilatation of Homograft in the Pulmonary Position?

“… 4) 5) 17) 18) 19) Consistently, we found that balloon dilatation in pulmonary homografts provided better results than aortic or femoral vein homografts, although the reasons behind these differences are not entirely clear. Bertels et al 7) reported favorable effects after balloon dilatation of homografts, but could not identify any significant factors predictive of a favorable effect. Powell et al 10) proposed that absence of calcification and younger conduit age are factors associated with better results.…”

“…The group with favorable results after balloon dilatation had a longer interval from conduit insertion, although the difference was not significant (27.0 months vs. 22.3 months), which was similar to Bertels et al's findings. 7) We also did not evaluate calcification in our study, as this parameter is difficult to quantify.…”

“… 15) Balloon size compared to conduit size was not a factor associated with good outcomes in our study, consistent with the results of previous studies. 6) 7) 20) Balloon pressure rather than balloon size might be important, because good results have been reported with ultra-noncompliant balloons for angioplasty of homografts. 8) We used both high pressure and conventional balloons because of limited availability.…”

“… 4) 5) Although the most effective alternate palliation is conduit replacement, there have been various efforts to reduce the risk associated with repetitive replacements, such as balloon dilatation, stent implantation, and percutaneous pulmonary valve implantation. 6) 7) 8) 9) 10) 11) 12) The effect of balloon dilatation of homografts in the pulmonary position in congenital heart disease is controversial due to the difficulty in defining efficacy and the small size of published studies. Some studies have reported that balloon dilatation fails to prolong homograft life and recommend abandoning balloon dilation of homograft conduits.…”

“… 2) 3) 6) 13) However, recent retrospective studies have concluded that balloon dilatation of homograft conduits in the pulmonary position has a favorable effect. 7) 8) Balloon dilatation of homografts in children or adolescents can postpone surgical valve or percutaneous valve implantation by 1 or 2 years, reducing the overall number of valve replacements needed. Accordingly, we retrospectively reviewed our experience to determine whether balloon dilatation is associated with postponement of conduit replacement.…”