The influence of valve physiology on outcome following aortic valvotomy for congenital bicuspid valve in children: 30-year results from a single institution

Karamlou, Tara; Shen, Irving; Alsoufia, Bahaaldin; Burch, Grant H.; Reller, Mark D.; Silberbach, Michael; Ungerleider, Ross M.

doi:10.1016/j.ejcts.2004.10.044

Cited by 25 publications

(4 citation statements)

References 25 publications

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“…Finally, center approach may vary as BAV potentially allows for a staged approach, either as a means to delay until SAV or with more frequent but more “gentle” dilation of the valve, thereby leaving more stenosis but avoiding regurgitation. The majority of patients with residual/recurrent stenosis after BAV are treated with repeat BAV, whereas those with insufficiency or mixed stenosis and insufficiency are treated surgically, typically with valve replacement . Notably, our data do not entirely fit this latter hypothesis as, although not quite statistically significant, there was more aortic regurgitation after BAV ( P =0.09), and patients demonstrated greater residual echocardiographic peak Doppler gradients ( P =0.06).…”

Section: Discussionmentioning

confidence: 59%

Surgical Valvotomy Versus Balloon Valvuloplasty for Congenital Aortic Valve Stenosis: A Systematic Review and Meta‐Analysis

Hill

Ginde

Rios

et al. 2016

JAHA

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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.

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Section: Discussionmentioning

confidence: 59%

Surgical Valvotomy Versus Balloon Valvuloplasty for Congenital Aortic Valve Stenosis: A Systematic Review and Meta‐Analysis

Hill

Ginde

Rios

et al. 2016

JAHA

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“…Auld et al ( 24 ) found that postoperative AI could predict worse freedom from intervention. Other previous studies demonstrated that patients with postoperative AI were likely to require early AoV replacement ( 24 , 25 ), which can be explained by the fact that volume overload is more difficult for adjustment by the left ventricular myocardium than pressure overload ( 5 ). Furthermore, repair for individuals with combined AS and AI is more challenging.…”

Section: Discussionmentioning

confidence: 98%

Long-term outcomes of primary aortic valve repair in children with congenital aortic stenosis – 15-year experience at a single center

Ren

Yu²,

Chen³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundStudies on the long-term outcomes of children with congenital aortic stenosis who underwent primary aortic repair are limited. We reviewed the long-term outcomes of children who underwent aortic valve (AoV) repair at our center.MethodsAll children (n = 75) who underwent AoV repair between 2006 and 2020 were reviewed. The Kaplan-Meier curve was used to demonstrate the survival estimates. The Cox proportional hazard model and competing risk regression model were used to identify risk factors for death, reintervention, adverse events, and replacement.ResultsThe median age at surgery was 1.8 (IQR, 0.2–7.7) years, and the median weight at surgery was 10.0 (IQR, 5.0–24.0) kg. Early mortality and late mortality were 5.3% (4/75) and 5.6% (4/71), respectively. Risk factors for overall mortality were concomitant mitral stenosis (P = 0.01, HR: 9.8, 95% CI: 1.8–53.9), low AoV annulus Z-score (P = 0.01, HR: 0.6, 95% CI: 0.4–0.9), and prolonged cardiopulmonary bypass time (P < 0.01, HR: 9.5, 95% CI: 1.7–52.1). Freedom from reintervention was 72.9 ± 0.10% (95% CI: 56.3–94.4%) at 10 years. Risk factors for occurrence of adverse event on multivariable analysis included preoperative intubation (P = 0.016, HR: 1.004, 95% CI: 1.001–1.007) and a low AoV annulus Z-score (P = 0.019, HR: 0.714, 95% CI: 0.540–0.945). Tricuspid AoV morphology was associated with a suboptimal postoperative outcome (P = 0.03).ConclusionAortic valve repair remains a safe and durable solution for children with congenital aortic stenosis. Concomitant mitral stenosis and aortic valve anatomy, including tricuspid valve morphology and smaller annulus size, are associated with poor early and long-term outcomes.

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“…LV myocardium was unable to adapt to volume overload as well as it did to pressure overload. 17 Vergnat et al 4 adopted a more gentle dilation (balloon/ annulus ratio <0.7), not aiming to relieve the AVS but rather attempting to achieve LV function recovery and longer time to next decision. Application of a small balloon could also minimize the risk of femoral artery damage.…”

Section: Discussionmentioning

confidence: 99%

Surgical and Transcatheter Treatments in Children with Congenital Aortic Stenosis

Zhu

Wen

et al. 2020

Thorac Cardiovasc Surg

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Background For patients with congenital aortic valve stenosis (AVS), comprehensive analysis of surgical aortic valvuloplasty (SAV) or balloon dilation (BD) is scarce and remains controversial. Methods This study reviewed AVS data (aortic peak gradient, aortic insufficiency, and survival and reoperation) for patients who were suitable for biventricular repair at our center in 2008 to 2018. Patients were categorized into two subgroups based on age (≤3 or >3 months). Results A total of 194 patients were treated, including 124 with SAV and 70 with BD. Resulting data revealed that residual aortic gradient at discharge was worse for BD (p = 0.001). While for patients younger than 3 months, the relief of AVS was comparable between the two groups (p = 0.624). There was no significant difference in time-related survival between the two groups (log-rank p = 0.644). Multivariate analysis demonstrated that preoperative left ventricular end-diastolic dimension predicted early death (p = 0.045). Survival in the two groups after 10 years was 96.8% in SAV and 95.7% in BD (p = 0.644). Freedom from reoperation after 10 years was 58.1% in SAV and 41.8% in BD patients (p = 0.01). There was no significant difference in freedom from reoperation between SAV and BD in patients younger than 3 months (p = 0.84). Multivariate analysis indicated that residual aortic peak gradient was predictive of reoperation (p = 0.038). Conclusion Both methods achieved excellent survival outcomes at our center. SAV achieved superior gradient reduction and minimized the necessity for reoperation. For patients younger than 3 months, BD rivaled SAV both in aortic stenosis relief and freedom from reoperation.

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The influence of valve physiology on outcome following aortic valvotomy for congenital bicuspid valve in children: 30-year results from a single institution

Cited by 25 publications

References 25 publications

Surgical Valvotomy Versus Balloon Valvuloplasty for Congenital Aortic Valve Stenosis: A Systematic Review and Meta‐Analysis

Surgical Valvotomy Versus Balloon Valvuloplasty for Congenital Aortic Valve Stenosis: A Systematic Review and Meta‐Analysis

Long-term outcomes of primary aortic valve repair in children with congenital aortic stenosis – 15-year experience at a single center

Surgical and Transcatheter Treatments in Children with Congenital Aortic Stenosis

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