Aortic Valve Reintervention After Balloon Aortic Valvuloplasty for Congenital Aortic Stenosis: Intermediate and Late Follow-Up

Brown, David W.; Dipilato, Amy E.; Chong, Erin C.; Lock, James E.; McElhinney, Doff B.

doi:10.1016/s0735-1097(10)60437-8

Cited by 7 publications

(13 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Balloon valvotomy or open surgical valvotomy are used as the initial intervention in neonates and children with aortic valve stenosis, but regardless of initial strategy many require further surgical intervention within 10 years. [1][2][3] The small size of the child at this stage often prohibits the use of an adult size prosthesis and therefore management strategies have evolved to include the use of either aortic leaflet repair or reconstruction until annular growth allows for a more durable prosthesis placement. Recent literature reports favorable comprehensive outcomes for the use of multiple techniques of aortic valve repair in children, 4 although the durability of many repair techniques is still debated.…”

Section: Perspectivementioning

confidence: 99%

The utility of aortic valve leaflet reconstruction techniques in children and young adults

Wiggins

Mimic

Issitt

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

Section: Perspectivementioning

confidence: 99%

The utility of aortic valve leaflet reconstruction techniques in children and young adults

Wiggins

Mimic

Issitt

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

“…High reintervention rates have been reported in previous studies as well, with freedom from aortic valve reintervention at 10 years ranging from 29% to 54%. 24,25 In our series, the most common indication for reintervention was residual AS, which accounted for 57% of the reinterventions. This is related to a conservative approach to dilation, using a balloon-annulus diameter ratio of ≈0.9, in an effort to avoid significant residual AI.…”

Section: Discussionmentioning

confidence: 68%

Trajectory of Left Ventricular Remodeling in Children With Valvar Aortic Stenosis Following Balloon Aortic Valvuloplasty

Papneja

Blatman

Kawpeng

et al. 2022

Circ: Cardiovascular Imaging

View full text Add to dashboard Cite

Background: Aortic valve stenosis is the most common type of congenital left ventricular (LV) outflow tract obstruction. Balloon aortic valvuloplasty (BAV) has become the first-line treatment pathway in many centers. Our aim was to assess the trajectory of LV remodeling following BAV in children and its relationship to residual aortic stenosis (AS) and insufficiency (AI). Methods: Children <18 years of age who underwent BAV for isolated aortic stenosis from 2004 to 2012 were eligible for inclusion. Those with AI before BAV, other complex congenital heart lesions, or <2 accessible follow-up echocardiograms were excluded. Baseline and serial echocardiographic data pertaining to aortic valve and LV size and function were retrospectively collected through December 2017 or the first reintervention. Longitudinal data was assessed using per-patient time profiles with superimposed trend lines using locally estimated scatterplot smoothing. Associations with reintervention or death were also evaluated. Results: Among the 98 enrolled children, the median (interquartile range) age at BAV was 2.8 months (0.2–75). The median (interquartile range) follow-up was 6.8 years (1.9–9.0). Children with predominantly residual AI (n=11) demonstrated progressive increases in their LV end-diastolic dimension Z score within the first 3 years after the BAV, followed by a plateau ( P <0.001). Their mean LV circumferential and longitudinal strain values remained within the normal range but lower than in the non-AI group ( P <0.001 and P =0.001, respectively). Children with predominantly residual aortic stenosis (n=44) had no changes in LV dimensions but had a rapid early increase in mean LV circumferential and longitudinal strain. The cumulative proportion (95% CI) of reintervention at 5 years following BAV was 33.7% (23.6%–42.4%). Conclusions: Our study demonstrates that LV remodeling occurs mainly during the first 3 years in children with predominantly residual AI after BAV, with no subsequent significant functional changes over the medium term. These data improve our understanding of expected patient trajectories and thus may inform decisions on the timing of reintervention.

show abstract

“…For example, an isolated congenital defect such as congenital aortic stenosis may be managed by balloon valvuloplasty, whereas complex defects such as tetralogy of Fallot with absent pulmonary valve or Shone syndrome are usually managed with surgical repair. Many procedures are palliative 7–9 . The most common primary diagnosis among infants undergoing aortic valve replacement or the Ross procedure is valvular and subvalvular aortic stenosis 10 …”

Section: Discussionmentioning

confidence: 99%

Donor supply for partial heart transplantation in the United States

Quintao

Kwon

Bishara

et al. 2023

Clinical Transplantation

View full text Add to dashboard Cite

BackgroundCongenital heart disease (CHD) is the most common cause of birth defects worldwide. Valvular defects are a common form of CHDs, and, at this time, treatment options for children with unrepairable valve disease are limited. Issues with anticoagulation, sizing, and lack of growth in valve replacement options can lead to high mortality rates and incidence of reoperations. Partial heart transplantation, or transplantation of fresh valve allografts, has recently been described as a strategy to provide a durable and non‐thrombogenic alternative to conventional prostheses and provide growth potential in pediatric patients.MethodsThe United Network for Organ Sharing (UNOS) database was queried to analyze the number of pediatric donor hearts that were not recovered but had viable valves (n = 3565) between January 2010 and September 2021. Recoverable valves were grouped by donor age: infants (age < 1 year), toddlers (age ≥1 and <3 years), and children (age ≥3 and <18 years). Demographic characteristics of donors were analyzed between age groups.ResultsInfants, toddlers, and children had a total of 344, 465, and 2756 hearts with recoverable valves, respectively, over the study period, representing an average of 29, 39, and 230 hearts with recoverable valves per year.ConclusionThe results of our study identify the minimum donor supply for partial heart transplantation. The actual number is likely higher because it includes hearts not entered in the UNOS database and domino transplants from orthotopic heart transplant recipients. Partial heart transplantation is logistically feasible as there are recoverable valves available for all age groups, fulfilling a clinical need in pediatric patients with unrepairable valve disease.

show abstract

Aortic Valve Reintervention After Balloon Aortic Valvuloplasty for Congenital Aortic Stenosis: Intermediate and Late Follow-Up

Cited by 7 publications

References 0 publications

The utility of aortic valve leaflet reconstruction techniques in children and young adults

The utility of aortic valve leaflet reconstruction techniques in children and young adults

Trajectory of Left Ventricular Remodeling in Children With Valvar Aortic Stenosis Following Balloon Aortic Valvuloplasty

Donor supply for partial heart transplantation in the United States

Contact Info

Product

Resources

About