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Balloon dilatation versus surgical valvotomy for congenital aortic stenosis: a propensity score matched study
Benjamin C Auld1,2, Julia S Donald3,4,5, Naychi Lwin1,2
1Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Australia.
Insights
Balloon valvuloplasty and surgical aortic valvotomy offer similar reintervention rates for congenital aortic stenosis. Balloon valvuloplasty effectively delays or avoids surgery across pediatric age groups.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Congenital aortic stenosis in children is primarily treated with balloon valvuloplasty or surgical aortic valvotomy.
- Limited comparative literature exists, leading to center bias in treatment selection.
Purpose of the Study:
- To conduct an unbiased, contemporary matched comparison of balloon valvuloplasty and surgical aortic valvotomy for pediatric congenital aortic stenosis.
Main Methods:
- Retrospective analysis of patients undergoing balloon valvuloplasty or surgical valvotomy (2005-2016).
- Exclusion of patients ineligible for either procedure.
- Propensity score matching based on age, weight, and valve morphology.
Main Results:
- 65 balloon and 77 surgical patients were analyzed; groups were well-matched.
- No significant difference in freedom from reintervention at medium-term follow-up (69% balloon vs. 70% surgical).
- One late balloon death and two early surgical deaths were reported.
Conclusions:
- Balloon valvuloplasty and surgical aortic valvotomy demonstrate comparable reintervention rates in the medium term.
- Balloon valvuloplasty is effective across pediatric age groups, potentially delaying or avoiding surgical intervention.
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.
