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Role of echocardiographic scoring systems in predicting successful biventricular versus univentricular palliation in neonates with critical aortic stenosis

Published online by Cambridge University Press:  03 September 2020

Shagun Sachdeva Open the ORCID record for Shagun Sachdeva [Opens in a new window] ,
Evelyn Kuhn ,
Peter C. Frommelt  and
Stephanie Handler
Shagun Sachdeva*
Affiliation:
Baylor College of Medicine, Houston, TX, USA
Evelyn Kuhn
Affiliation:
Medical College of Wisconsin, Milwaukee, WI, USA
Peter C. Frommelt
Affiliation:
Medical College of Wisconsin, Milwaukee, WI, USA
Stephanie Handler
Affiliation:
Medical College of Wisconsin, Milwaukee, WI, USA
*
Author for correspondence: Shagun Sachdeva, MD, Texas Children’s Hospital, Baylor College of Medicine, 6651 Main St, Houston, TX77030, USA. Tel: +1 832 826 5600. E-mail: shagun.sachdeva@bcm.edu
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Abstract

Background:

There are several published echo-derived scores to help predict successful biventricular versus univentricular palliation in neonates with critical aortic stenosis. This study aims to determine whether any published scoring system accurately predicted outcomes in these neonates.

Methods:

Single centre, retrospective cohort study including neonates who underwent aortic valve intervention (surgical valvotomy or balloon valvuloplasty) with the intention of biventricular circulation. Primary outcome was survival with biventricular circulation at hospital discharge. Data from their initial neonatal echocardiogram were used to compute the following scores – Rhodes, CHSS 1, Discriminant, CHSS 2, and 2 V.

Results:

Between 01/1999 and 12/2017, 68 neonates underwent aortic valve intervention at a median age of 4 days (range 1–29 days); 35 surgical valvotomy and 33 balloon valvuloplasty. Survival with biventricular circulation was maintained in 60/68 patients at hospital discharge. Of the remaining eight patients, three were converted to univentricular palliation, four died, and one underwent heart transplant prior to discharge. None of the binary score predictions of biventricular versus univentricular (using that score’s proposed cut-offs) were significantly associated with the observed outcome in this cohort. A high percentage of those predicted to need univentricular palliation had successful biventricular repair: 89.4% by Rhodes, 79.3% by CHSS 1, 85.2% by Discriminant, and 66.7% by CHSS 2 score. The 2 V best predicted outcome and agreed with the local approach in most cases.

Conclusion:

This study highlights the limitations of and need for alternative scoring systems/cut-offs for consistently accurate echocardiographic prediction of early outcome in neonates with critical aortic stenosis.

Keywords

Critical aortic stenosisechocardiographyaortic valvotomyaortic valvuloplasty
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 11 , November 2020 , pp. 1702 - 1707
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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