Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-22T06:26:05.033Z Has data issue: false hasContentIssue false
  • English
  • Français

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: ralexy@iu.edu
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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