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Balloon Aortic Valvuloplasty for Congenital Aortic Stenosis: A 14-Year Single Centre Review
Benjamin Auld1, Lindsay Carrigan1, Cameron Ward2
1Queensland Paediatric Cardiac Service, Lady Cilento Children's Hospital, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
Insights
Balloon aortic valvuloplasty (BAV) is effective for congenital aortic stenosis (AS), avoiding surgery in most children. Success depends on valve appearance and immediate post-procedure gradient and leakage.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Congenital aortic stenosis (AS) management varies by center, with differing preferences for catheter-based or surgical interventions.
- Investigating outcomes of primary balloon aortic valvuloplasty (BAV) is crucial for understanding its efficacy in pediatric AS.
Purpose of the Study:
- To assess the association between primary balloon aortic valvuloplasty (BAV) and freedom from re-intervention (FFI) in children with congenital aortic stenosis (AS).
- To identify predictors of re-intervention after BAV in this cohort.
Main Methods:
- Retrospective analysis of pediatric patients undergoing primary BAV for congenital AS between 2001 and 2015.
- Collection of pre- and post-procedural echocardiographic data and procedural details.
Main Results:
- 75% of 60 patients achieved freedom from re-intervention (FFI) with a median follow-up of 6.8 years after BAV.
- Aortic valve morphology, post-BAV gradient, and post-BAV regurgitation were significant predictors of FFI.
- No re-interventions occurred for restenosis when the post-BAV mean echo gradient was below 30mmHg.
Conclusions:
- Balloon aortic valvuloplasty (BAV) serves as an effective primary treatment for congenital valvular aortic stenosis (AS), potentially averting surgical intervention across all age groups.
- Key factors influencing freedom from re-intervention include initial valve morphology and the immediate post-procedural hemodynamic status (stenosis and regurgitation).
Background:
The approach to intervention for congenital aortic valve stenosis (AS) differs depending upon centre bias toward a primary catheter or surgical approach. We therefore investigated associations with freedom from re-intervention (FFI) in the cohort of children who underwent primary balloon aortic valvuloplasty (BAV) for congenital AS in our centre.
Methods:
All patients who underwent BAV as a primary procedure in the period between 2001 and 2015 in a single service were included. Echocardiographic parameters before and after catheterisation and procedural data was collected on all patients.
Results:
Sixty-four (64) patients underwent BAV as the primary intervention during the study period. Follow-up data was available for 60 of these. Balloon aortic valvuloplasty was performed at a median age of 143 days (range 2 days-18.8 years). Freedom from re-intervention was observed in 75% of patients with a median follow-up of 6.8 years and a mean follow-up of 3 years. Catheter-based peak-to-peak aortic valve gradients decreased from 58±15.9mmHg to 22.9±13.1mmHg. There was no short- or long-term mortality. FFI was predicted by aortic valve morphology (p<0.01), post-BAV mean echo gradient (p=0.03) and post-BAV regurgitation (p<0.01). No patient had re-intervention for restenosis with post-BAV mean echo gradient <30mmHg. Catheter gradients before and after BAV approached significance for predicting FFI (p=0.06 and p=0.09 respectively). Fifteen (15) patients were neonates with significantly lower aortic valve (AoV) Z-scores (mean 0.63 vs 1.76, p=0.002) and no difference in FFI (p=0.19). Annulus size, balloon/annulus ratio (within the range utilised) and pre-BAV echo findings were not predictive for re-intervention.
Conclusions:
Balloon aortic valvuloplasty is an effective primary approach to congenital valvular AS with the potential of avoiding surgical intervention in the majority of patients at all ages. Freedom from re-intervention in our cohort was associated with valve morphology and the degree of stenosis and regurgitation immediately post BAV.
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