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Balloon dilatation versus surgical valvotomy for congenital aortic stenosis: a propensity score matched study

Published online by Cambridge University Press:  16 April 2021

Benjamin C. Auld
Affiliation:
Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, Australia UQ School of Medicine, University of Queensland, St Lucia, Australia
Julia S. Donald
Affiliation:
Royal Children’s Hospital, Melbourne, Australia University of Melbourne, Parkville, Australia Murdoch Children’s Research Institute, Parkville, Australia
Naychi Lwin
Affiliation:
Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, Australia UQ School of Medicine, University of Queensland, St Lucia, Australia
Kim Betts
Affiliation:
School of Public Health, Curtin University, Bentley, Australia
Nelson O. Alphonso
Affiliation:
Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, Australia UQ School of Medicine, University of Queensland, St Lucia, Australia
Prem S. Venugopal
Affiliation:
Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, Australia UQ School of Medicine, University of Queensland, St Lucia, Australia
Robert N. Justo
Affiliation:
Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, Australia UQ School of Medicine, University of Queensland, St Lucia, Australia
Cameron J. Ward
Affiliation:
Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, Australia UQ School of Medicine, University of Queensland, St Lucia, Australia
Igor E. Konstantinov
Affiliation:
Royal Children’s Hospital, Melbourne, Australia University of Melbourne, Parkville, Australia Murdoch Children’s Research Institute, Parkville, Australia
Tom R. Karl
Affiliation:
Johns Hopkins School of Medicine, Baltimore, USA
Benjamin W. Anderson
Affiliation:
Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, Australia UQ School of Medicine, University of Queensland, St Lucia, Australia
Corresponding

Abstract

Background:

Balloon valvuloplasty and surgical aortic valvotomy have been the treatment mainstays for congenital aortic stenosis in children. Choice of intervention often differs depending upon centre bias with limited relevant, comparative literature.

Objectives:

This study aims to provide an unbiased, contemporary matched comparison of these balloon and surgical approaches.

Methods:

Retrospective analysis of patients with congenital aortic valve stenosis who underwent balloon valvuloplasty (Queensland Children’s Hospital, Brisbane) or surgical valvotomy (Royal Children’s Hospital, Melbourne) between 2005 and 2016. Patients were excluded if pre-intervention assessment indicated ineligibility to either group. Propensity score matching was performed based on age, weight, and valve morphology.

Results:

Sixty-five balloon patients and seventy-seven surgical patients were included. Overall, the groups were well matched with 18 neonates/25 infants in the balloon group and 17 neonates/28 infants in the surgical group. Median age at balloon was 92 days (range 2 days – 18.8 years) compared to 167 days (range 0 days – 18.1 years) for surgery (rank-sum p = 0.08). Mean follow-up was 5.3 years. There was one late balloon death and two early surgical deaths due to left ventricular failure. There was no significant difference in freedom from reintervention at latest follow-up (69% in the balloon group and 70% in the surgical group, p = 1.0).

Conclusions:

Contemporary analysis of balloon aortic valvuloplasty and surgical aortic valvotomy shows no difference in overall reintervention rates in the medium term. Balloon valvuloplasty performs well across all age groups, achieving delay or avoidance of surgical intervention.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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