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Long-Term Outcomes and Predictors After Percutaneous Balloon Pulmonary Valvuloplasty for Pediatric Isolated Valvular
Mariana M Pereira1, Joana O Miranda2,3
1Faculty of Medicine, University of Porto, Porto, Portugal.
Insights
Percutaneous Balloon Pulmonary Valvuloplasty (BPV) offers sustained relief for pediatric pulmonary valve stenosis with low mortality. Key factors influencing restenosis and pulmonary insufficiency include baseline anatomy and hemodynamics.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Percutaneous Balloon Pulmonary Valvuloplasty (BPV) is the standard treatment for pediatric pulmonary valve stenosis.
- Long-term outcomes and risk factors for BPV require further characterization.
Purpose of the Study:
- To systematically review long-term outcomes of BPV in pediatric patients.
- To identify predictors of restenosis, reintervention, and pulmonary insufficiency (PI) post-BPV.
Main Methods:
- Systematic review of PubMed, Scopus, Web of Science, and Cochrane databases.
- Included studies with pediatric populations and ≥5 years follow-up (up to 20 years).
- Analyzed data from 15 studies involving 1505 patients.
Main Results:
- BPV provided sustained stenosis relief with low procedure-related (0-4.2%) and late mortality (0-6%).
- Restenosis (0-38%) and reintervention (median 5.0% repeat BPV, 4.5% surgery) were linked to unfavorable hemodynamics and smaller annulus size.
- Pulmonary insufficiency (5.6%-60%) was associated with younger age, lower weight, and severe baseline stenosis.
Conclusions:
- BPV is effective for pediatric pulmonary valve stenosis, with generally favorable long-term results.
- Anatomical, hemodynamic, and procedural factors significantly impact restenosis, reintervention, and PI.
- Heterogeneity in outcome definitions necessitates cautious interpretation of synthesized results.
Abstract:
Percutaneous Balloon Pulmonary Valvuloplasty (BPV) is the gold standard treatment for isolated pulmonary valve stenosis in the pediatric population. However, its long-term outcomes and associated risk factors remain incompletely characterized. This systematic review aimed to assess BPV long-term outcomes and predictors for restenosis/reintervention and pulmonary insufficiency (PI) following BPV in this population. PubMed, Scopus, Web of Science and Cochrane databases were searched to identify studies including pediatric populations with a minimum follow up of five years after BPV (ranging up to 20 years). Fifteen studies were included, comprising 1505 patients. BPV was associated with sustained relief of pulmonary valve stenosis and low procedure-related and late mortality (ranges 0-4.2% and 0-6%, respectively). Restenosis occurred in a minority of patients, (range 0-38%), and reintervention was uncommon (median rates: repeat BPV 5.0%, surgery 4.5%). Both were consistently associated with unfavorable hemodynamic characteristics including a higher initial transvalvular pulmonary gradient or a higher right ventricular overload and residual obstruction after the procedure, as well as unfavorable anatomical characteristics including a smaller pulmonary valve annulus size. PI was the most frequently late outcome identified (range 5.6%-60%), and was predominantly associated with younger age at intervention, lower body weight and greater severity of stenosis at baseline. Pulmonary valve replacement remained uncommon during follow-up (range 0-12.3%, median 1.4%). These results highlight the differential impact of anatomical, hemodynamic and procedural factors on long-term outcomes after BPV in pediatric patients. Due to substantial heterogeneity in outcome definitions and gradient assessment methods, results were synthesized narratively.
