Short- and intermediate-term results of balloon aortic valvuloplasty and surgical aortic valvotomy in neonates

Zaban, Nicholas B.; Herrmann, Jeremy L.; Hoyer, Mark V.; Brown, John W.; Alexy, Ryan

doi:10.1017/s1047951120000372

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…aortic insufficiency AS aortic stenosis AVR aortic valve replacement AVR aortic valve replacement BAD balloon aortic dilation CHD congenital heart disease LVOT left ventricular outflow tract SAV surgical aortic valvuloplasty up to 5 years in the BAD group. 12 For the present study, we aimed to evaluate longer term outcomes following surgical valvuloplasty and balloon dilation in pediatric patients >60 days old with congenital AS.…”

Section: Aimentioning

confidence: 99%

“…7,9 –11 Recently, our institution evaluated initial SAV and BAD approaches in patients ≤60 days of age and found similar reductions in valve gradients postprocedure but more significant and more frequent aortic insufficiency (AI) at up to 5 years in the BAD group. 12 For the present study, we aimed to evaluate longer term outcomes following surgical valvuloplasty and balloon dilation in pediatric patients >60 days old with congenital AS.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Valvuloplasty Versus Balloon Dilation for Congenital Aortic Stenosis in Pediatric Patients

Herrmann

Clark

Colgate

et al. 2020

World J Pediatr Congenit Heart Surg

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Background: For children with congenital aortic stenosis (AS) who are candidates for biventricular repair, valvuloplasty can be achieved by surgical aortic valvuloplasty (SAV) or by transcatheter balloon aortic dilation (BAD). We aimed to evaluate the longer term outcomes of SAV versus BAD at our institution. Methods: We retrospectively reviewed the outcomes of 2 months to 18 years old patients who underwent SAV or BAD at our institution between January 1990 and July 2018. Baseline and follow-up characteristics were assessed by echocardiography. Long-term survival, freedom from reintervention, freedom from aortic valve replacement (AVR), and aortic regurgitation were evaluated. Results: A total of 212 patients met inclusion criteria (SAV = 123; BAD = 89). Age, sex, aortic insufficiency (AI), and aortic valve gradient were similar between the groups. At 10 years, 27.9% (19/68) of SAV patients and 58.3% (28/48) of BAD patients had moderate or worse AI ( P = .001), and reintervention occurred in 39.2% (29/74) of SAV patients and 78.6% (44/56) of BAD patients ( P < .001). Kaplan-Meier analysis revealed overall survival was 96.8% (119/123) for SAV and 95.5% (85/89) for SAV ( P = .87). At 10 years, 35% (23/66) of SAV patients and 54% (23/43) of BAD patients underwent AVR ( P = .213). Conclusions: Surgical aortic valvuloplasty demonstrated greater gradient reduction, less postoperative and long-term AI, and a lower reintervention rate at 10 years than BAD. There was no difference in survival or AVR reintervention rate. Surgical aortic valvuloplasty is a durable and efficacious intervention and should continue to be considered a favorable choice for palliation of valvular AS.

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Section: Aimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Valvuloplasty Versus Balloon Dilation for Congenital Aortic Stenosis in Pediatric Patients

Herrmann

Clark

Colgate

et al. 2020

World J Pediatr Congenit Heart Surg

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“…1 There is no generally accepted definition of critical VAS. In the literature, the definitions includes: age at intervention, <30 days 2 3 or <3 months [4][5][6][7] ; anatomic features such as duct dependency 8 9 ; functional features such as depressed left ventricular function 10 ; ongoing pharmacological treatment with prostaglandin or inotrope support 11 12 ; or as a combination of criteria. 1 13-15 Another group of neonates with VAS present in good clinical condition with a heart murmur, and the indication for treatment in the neonatal period is a significant gradient across the aortic valve.…”

Section: Introductionmentioning

confidence: 99%

“…There is no generally accepted definition of critical VAS. In the literature, the definitions includes: age at intervention, <30 days2 3 or <3 months4–7; anatomic features such as duct dependency8 9; functional features such as depressed left ventricular function10; ongoing pharmacological treatment with prostaglandin or inotrope support11 12; or as a combination of criteria 1 13–15…”

Section: Introductionmentioning

confidence: 99%

Outcomes in neonatal critical and non-critical aortic stenosis: a retrospective cohort study

et al. 2023

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ObjectiveTo compare long-term survival, reinterventions and risk factors using strict definitions of neonatal critical and non-critical valvular aortic stenosis (VAS).DesignA nationwide retrospective study using data from patient files, echocardiograms and the Swedish National Population Registry.Setting and patientsAll neonates in Sweden treated for isolated VAS 1994–2018. We applied the following criteria for critical aortic stenosis: valvular stenosis with duct-dependent systemic circulation or depressed left ventricular function (fractional shortening ≤27%). Indication for treatment of non-critical VAS was Doppler mean gradient >50 mm Hg.Main outcome measuresShort-term and long-term survival, aortic valve reinterventions need of valve replacements, risk factors for reintervention and event-free survival.ResultsWe identified 65 patients with critical VAS and 42 with non-critical VAS. The majority of the neonates were managed by surgical valvotomy. Median follow-up time was 13.5 years, with no patients lost to follow-up. There was no 30-day mortality. Long-term transplant-free survival was 91% in the critical stenosis group and 98% in the non-critical stenosis group (p=0.134). Event-free survival was 40% versus 67% (p=0.002) in the respective groups. Median time from the initial treatment to reintervention was 3.6 months versus 3.9 years, respectively (p=0.008).ConclusionsCritical VAS patients had significantly higher need for reintervention during the first year of life, lower event-free survival and lower freedom from aortic valve replacement at age ≥18 years, compared with neonates with non-critical stenosis.

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“…11,12 Aortic valve insufficiency may be well-tolerated acutely, but over time is progressive, and in the setting of left ventricular dilatation, can by itself be an indication for aortic valve replacement or surgical palliation. 13,14 As valve insufficiency remains a common complication of aortic valvuloplasty that can significantly influence long-term outcomes, 5,15,16 advances that reduce valve insufficiency but preserve gradient reduction should continuously be pursued.…”

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confidence: 99%

Echocardiographic versus angiographic measurement of the aortic valve annulus in children undergoing balloon aortic valvuloplasty: method affects outcomes

et al. 2020

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Objective: Operators are mindful of the balloon-to-aortic annulus ratio when performing balloon aortic valvuloplasty. The method of measurement of the aortic valve annulus has not been standardised. Methods and results: Patients who underwent aortic valvuloplasty at two paediatric centres between 2007 and 2014 were included. The valve annulus measured by echocardiography and angiography was used to calculate the balloon-to-aortic annulus ratio and measurements were compared. The primary endpoint was an increase in aortic insufficiency by ≥2 degrees. Ninety-eight patients with a median age at valvuloplasty of 2.1 months (Interquartile range (IQR): 0.2–105.5) were included. The angiographic-based annulus was 8.2 mm (IQR: 6.8–16.0), which was greater than echocardiogram-based annulus of 7.5 mm (IQR: 6.1–14.8) (p < 0.001). This corresponded to a significantly lower angiographic balloon-to-aortic annulus ratio of 0.9 (IQR: 0.9–1.0), compared to an echocardiographic ratio of 1.1 (IQR: 1.0–1.1) (p < 0.001). The degree of discrepancy in measured diameter increased with smaller valve diameters (p = 0.041) and in neonates (p = 0.044). There was significant disagreement between angiographic and echocardiographic balloon-to-aortic annulus ratio measures regarding “High” ratio of >1.2, with angiographic ratio flagging only 2/12 (16.7%) of patients flagged by echocardiographic ratio as “High” (p = 0.012). Patients who had an increase in the degree of aortic insufficiency post valvuloplasty, only 3 (5.5%) had angiographic ratio > 1.1, while 21 (38%) had echocardiographic ratio >1.1 (p < 0.001). Patients with resultant ≥ moderate insufficiency more often had an echocardiographic ratio of >1.1 than angiographic ratio of >1.1 There was no association between increase in balloon-to-aortic annulus ratio and gradient reduction. Conclusions: Angiographic measurement is associated with a greater measured aortic valve annulus and the development of aortic insufficiency. Operators should use caution when relying solely on angiographic measurement when performing balloon aortic valvuloplasty.

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Short- and intermediate-term results of balloon aortic valvuloplasty and surgical aortic valvotomy in neonates

Cited by 6 publications

References 15 publications

Surgical Valvuloplasty Versus Balloon Dilation for Congenital Aortic Stenosis in Pediatric Patients

Surgical Valvuloplasty Versus Balloon Dilation for Congenital Aortic Stenosis in Pediatric Patients

Outcomes in neonatal critical and non-critical aortic stenosis: a retrospective cohort study

Echocardiographic versus angiographic measurement of the aortic valve annulus in children undergoing balloon aortic valvuloplasty: method affects outcomes

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