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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: ralexy@iu.edu
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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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