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

Published online by Cambridge University Press:  24 February 2020

Nicholas B. Zaban Open the ORCID record for Nicholas B. Zaban [Opens in a new window] ,
Jeremy L. Herrmann ,
Mark H. Hoyer Open the ORCID record for Mark H. Hoyer [Opens in a new window] ,
John W. Brown  and
Ryan D. Alexy
Nicholas B. Zaban
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
Jeremy L. Herrmann
Affiliation:
Section of Congenital Cardiac Surgery, Department of Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
Mark H. Hoyer
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
John W. Brown
Affiliation:
Section of Congenital Cardiac Surgery, Department of Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
Ryan D. Alexy*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
*
Author for correspondence: R. D. Alexy, MD, Division of Pediatric Cardiology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite RR 127, Indianapolis, IN46254, USA. Tel: 317-274-8906; Fax: 317-274-4022. E-mail: [email protected]
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Abstract

Background:

Balloon aortic valvuloplasty and open surgical valvotomy are procedures to treat neonatal aortic stenosis, and there is controversy as to which method has superior outcomes.

Methods:

We reviewed the records of patients at our institution since 2000 who had a balloon aortic valvuloplasty or surgical valvotomy via an open commissurotomy prior to 2 months of age.

Results:

Forty patients had balloon aortic valvuloplasty and 15 patients had surgical valvotomy via an open commissurotomy. There was no difference in post-procedure mean gradient by transthoracic echocardiogram, which were 25.8 mmHg for balloon aortic valvuloplasty and 26.2 mmHg for surgical valvotomy, p = 0.87. Post-procedure, 15% of balloon aortic valvuloplasty patients had moderate aortic insufficiency and 2.5% of patients had severe aortic insufficiency, while no surgical valvotomy patients had moderate or severe aortic insufficiency. The average number of post-procedure hospital days was 14.2 for balloon aortic valvuloplasty and 19.8 for surgical valvotomy (p = 0.52). Freedom from re-intervention was 69% for balloon aortic valvuloplasty and 67% for surgical valvotomy at 1 year, and 43% for balloon aortic valvuloplasty and 67% for surgical valvotomy at 5 years (p = 0.60).

Conclusions:

Balloon aortic valvuloplasty and surgical valvotomy provide similar short-term reduction in valve gradient. Balloon aortic valvuloplasty has a slightly shorter but not statistically significant hospital stay. Freedom from re-intervention is similar at 1 year. At 5 years, it is slightly higher in surgical valvotomy, though not statistically different. Balloon aortic valvuloplasty had a higher incidence of significant aortic insufficiency. Long-term comparisons cannot be made given the lack of long-term follow-up with surgical valvotomy.

Keywords

congenital aortic stenosisballoon valvuloplastysurgical valvotomy
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 4 , April 2020 , pp. 489 - 492
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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References

Backer, CL. Infant congenital aortic valve stenosis: the pendulum swings. J Am Coll Cardiol 2013;62 (22): 2141–2143.CrossRefGoogle ScholarPubMed
Lababidi, Z, Wu, JR, Walls, JT. Percutaneous balloon aortic valvuloplasty: results in 23 patients. Am J Cardiol 1984; 53 (1): 194–197.CrossRefGoogle ScholarPubMed
Brown, JW, Ruzmetov, M, Vijay, P, Rodefeld, MD, Turrentine, MW. Closed transventricular aortic valvotomy for critical aortic stenosis in neonates: outcomes, risk factors, and reoperations. Ann Thorac Surg 2006; 81 (1): 236–242.CrossRefGoogle ScholarPubMed
Hraska, V. Neonatal aortic stenosis is a surgical disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2016; 19 (1): 2–5.CrossRefGoogle ScholarPubMed
Brown, JW, Rodefeld, MD, Ruzmetov, M, Eltayeb, O, Yurdakok, O, Turrentine, MW. Surgical valvuloplasty versus balloon aortic dilation for congenital aortic stenosis: are evidence-based outcomes relevant? Ann Thorac Surg 2012; 94 (1): 146–153; discussion 53-5.CrossRefGoogle ScholarPubMed
Maskatia, SA, Ing, FF, Justino, H, et al. Twenty-five year experience with balloon aortic valvuloplasty for congenital aortic stenosis. Am J Cardiol 2011; 108 (7): 1024–1028.CrossRefGoogle ScholarPubMed
Sullivan, PM, Rubio, AE, Johnston, TA, Jones, TK. Long-term outcomes and re-interventions following balloon aortic valvuloplasty in pediatric patients with congenital aortic stenosis: a single-center study. Catheter Cardiovasc Interv 2017;89 (2): 288–296.CrossRefGoogle ScholarPubMed
Petit, CJ, Ing, FF, Mattamal, R, Pignatelli, RH, Mullins, CE, Justino, H. Diminished left ventricular function is associated with poor mid-term outcomes in neonates after balloon aortic valvuloplasty. Catheter Cardiovasc Interv 2012; 80 (7): 1190–1199.CrossRefGoogle ScholarPubMed
Boe, BA, Zampi, JD, Kennedy, KF, et al. Acute success of balloon aortic valvuloplasty in the current era: a national cardiovascular data registry study. JACC Cardiovasc Interv 2017; 10 (17): 1717–1726.CrossRefGoogle ScholarPubMed
Rossi, RI, Manica, JL, Petraco, R, Scott, M, Piazza, L, Machado, PM. Balloon aortic valvuloplasty for congenital aortic stenosis using the femoral and the carotid artery approach: a 16-year experience from a single center. Catheter Cardiovasc Interv 2011; 78 (1): 84–90.CrossRefGoogle ScholarPubMed
Torres, A, Vincent, JA, Everett, A, et al. Balloon valvuloplasty for congenital aortic stenosis: Multi-center safety and efficacy outcome assessment. Catheter Cardiovasc Interv 2015; 86 (5): 808–820.CrossRefGoogle ScholarPubMed
Patel, S, Saini, AP, Nair, A, Weber, HS. Transcarotid balloon valvuloplasty in neonates and small infants with critical aortic valve stenosis utilizing continuous transesophageal echocardiographic guidance: A 22 year single center experience from the cath lab to the bedside. Catheter Cardiovasc Interv 2015; 86 (5): 821–827.CrossRefGoogle Scholar
Benson, L. Neonatal aortic stenosis is a surgical disease: an interventional cardiologist view. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2016; 19 (1): 6–9.CrossRefGoogle ScholarPubMed
Siddiqui, J, Brizard, CP, Galati, JC, et al. Surgical valvotomy and repair for neonatal and infant congenital aortic stenosis achieves better results than interventional catheterization. J Am Coll Cardiol 2013; 62 (22): 2134–2140.CrossRefGoogle ScholarPubMed
Agnoletti, G, Raisky, O, Boudjemline, Y, et al. Neonatal surgical aortic commissurotomy: predictors of outcome and long-term results. Ann Thorac Surg 2006; 82 (5): 1585–1592.CrossRefGoogle ScholarPubMed