Long Term Results of Percutaneous Balloon Valvoplasty of Congenital Aortic Stenosis: Independent Predictors of Outcome

Overview

Journal Heart

Date 2003 Dec 17

PMID 14676248

Citations 22

Authors

O Reich

P Tax

J Marek

V Razek

J Gilik

V Tomek

V Chaloupecky

H Bartakova

J Skovranek

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate long term results and independent predictors of outcome of aortic valvoplasty.

Design: Retrospective follow up study. Independent predictors of outcome identified by multiple logistic regression.

Setting: Tertiary referral centre.

Patients: 269 consecutive patients treated at the median age of 8 months (0-23 years): 80 (30%) under 4 weeks, 59 (22%) between 4 weeks and 1 year, and 130 (48%) over 1 year. The follow up period was up to 14.8 years (median 5.3, in survivors 6.4 years).

Interventions: Percutaneous balloon valvoplasty with mean (SD) balloon to annulus ratio 0.97 (0.08).

Main Outcome Measures: Restenosis > or = 70 mm Hg, grade 3 aortic insufficiency, cusps disruption, surgery, death, and valvoplasty failure (significant restenosis or insufficiency or surgery or death).

Results: The mortality rate was 10.4% (n = 28), the restenosis rate was 16.7% (n = 45), significant insufficiency developed in 22.3% (n = 60), surgery was needed in 20.1% (n = 54), and "valvoplasty failure" occurred in 41.6% (n = 112) patients. Mean (SEM) survival probability 14.4 years after the procedure was 0.89 (0.02) and mean (SEM) probability of surgery-free survival was 0.50 (0.08). The independent predictors were as follows. For restenosis: small aortic annulus; for cusp disruption: large aortic annulus; for insufficiency: bicuspid aortic valve; for need for surgery: bicuspid aortic valve; for death: small aortic annulus, low left ventricular shortening fraction, and low sequential number of the valvoplasty; and for valvoplasty failure: small aortic annulus, bicuspid aortic valve, and high grade of mitral insufficiency.

Conclusion: Independent predictors of unfavourable outcome are small aortic annulus, bicuspid aortic valve, poor function of left ventricle or mitral valve, and limited operator experience.

Citing Articles

Long-Term Results of Congenital Aortic Stenosis Treatment in the Era of Percutaneous Balloon Valvuloplasty: Up to 33 Years Follow-Up.

Materna O, Tax P, Tomek V, Koubsky K, Chaloupecky V, Janousek J J Am Heart Assoc. 2023; 12(12):e028837.

PMID: 37301755 PMC: 10356031. DOI: 10.1161/JAHA.122.028837.

Long-term outcomes of primary aortic valve repair in children with congenital aortic stenosis - 15-year experience at a single center.

Ren Q, Yu J, Chen T, Qiu H, Ji E, Liu T Front Cardiovasc Med. 2022; 9:1029245.

PMID: 36312277 PMC: 9613358. DOI: 10.3389/fcvm.2022.1029245.

Balloon Valvuloplasty for Congenital Aortic Stenosis: Experience at a Tertiary Center in a Developing Country.

Charafeddine F, Bou Houssein H, Kibbi N, El-Rassi I, Tabbakh A, Abutaqa M J Interv Cardiol. 2021; 2021:6681693.

PMID: 33519306 PMC: 7815385. DOI: 10.1155/2021/6681693.

Early and Intermediate-Term Outcome of Balloon Aortic Valvuloplasty in Children With Aortic Stenosis and Left Ventricular Dysfunction at Tertiary Care Hospital.

Chand R, Shaikh A, Kumar N, Korejo H, Sohail A, Kumari V Cureus. 2020; 12(5):e8321.

PMID: 32617200 PMC: 7325342. DOI: 10.7759/cureus.8321.

Percutaneous aortic balloon valvuloplasty under echocardiographic guidance solely.

Xie Y, Wang S, Zhao G, Li M, Zhang F, Ouyang W J Thorac Dis. 2020; 12(3):477-483.

PMID: 32274114 PMC: 7139023. DOI: 10.21037/jtd.2020.01.16.

References

Chartrand C, Vobecky J . Long-term results of surgical valvuloplasty for congenital valvar aortic stenosis in children. Ann Thorac Surg. 1999; 68(4):1356-9; discussion 1359-60. DOI: 10.1016/s0003-4975(99)00909-1. View

Borghi A, Agnoletti G, Valsecchi O, Carminati M . Aortic balloon dilatation for congenital aortic stenosis: report of 90 cases (1986-98). Heart. 1999; 82(6):e10. PMC: 1729224. DOI: 10.1136/hrt.82.6.e10. View

Robinson B, Weber H, Ksiazyk J, Fricker F, Fischer D, Ettedgui J . Balloon aortic valvotomy through a carotid cutdown in infants with severe aortic stenosis: results of the multi-centric registry. Cardiol Young. 2000; 10(3):225-32. DOI: 10.1017/s104795110000915x. View

Lababidi Z . Aortic balloon valvuloplasty. Am Heart J. 1983; 106(4 Pt 1):751-2. DOI: 10.1016/0002-8703(83)90097-2. View

Lababidi Z, Wu J, Walls J . Percutaneous balloon aortic valvuloplasty: results in 23 patients. Am J Cardiol. 1984; 53(1):194-7. DOI: 10.1016/0002-9149(84)90709-4. View

Lababidi Z, Weinhaus L . Successful balloon valvuloplasty for neonatal critical aortic stenosis. Am Heart J. 1986; 112(5):913-6. DOI: 10.1016/0002-8703(86)90299-1. View

Pelech A, Dyck J, Trusler G, Williams W, Olley P, Rowe R . Critical aortic stenosis. Survival and management. J Thorac Cardiovasc Surg. 1987; 94(4):510-7. View

Sholler G, Keane J, Perry S, Sanders S, Lock J . Balloon dilation of congenital aortic valve stenosis. Results and influence of technical and morphological features on outcome. Circulation. 1988; 78(2):351-60. DOI: 10.1161/01.cir.78.2.351. View

Rocchini A, Beekman R, Ben Shachar G, Benson L, Schwartz D, Kan J . Balloon aortic valvuloplasty: results of the Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Am J Cardiol. 1990; 65(11):784-9. DOI: 10.1016/0002-9149(90)91388-m. View

10.

Leung M, McKay R, Smith A, Anderson R, Arnold R . Critical aortic stenosis in early infancy. Anatomic and echocardiographic substrates of successful open valvotomy. J Thorac Cardiovasc Surg. 1991; 101(3):526-35. View

11.

OConnor B, Beekman R, Rocchini A, Rosenthal A . Intermediate-term effectiveness of balloon valvuloplasty for congenital aortic stenosis. A prospective follow-up study. Circulation. 1991; 84(2):732-8. DOI: 10.1161/01.cir.84.2.732. View

12.

First T, Skovranek J, Marek J . [Normal values of 2-dimensional echocardiographic parameters in children]. Cesk Pediatr. 1992; 47(5):260-4. View

13.

Solymar L, SUDOW G, Berggren H, Eriksson B . Balloon dilation of stenotic aortic valve in children. An intraoperative study. J Thorac Cardiovasc Surg. 1992; 104(6):1709-13. View

14.

Mosca R, Iannettoni M, Schwartz S, Ludomirsky A, Beekman 3rd R, Lloyd T . Critical aortic stenosis in the neonate. A comparison of balloon valvuloplasty and transventricular dilation. J Thorac Cardiovasc Surg. 1995; 109(1):147-54. DOI: 10.1016/S0022-5223(95)70430-2. View

15.

Gaynor J, Bull C, Sullivan I, ARMSTRONG B, Deanfield J, Taylor J . Late outcome of survivors of intervention for neonatal aortic valve stenosis. Ann Thorac Surg. 1995; 60(1):122-5; discussion 125-6. View

16.

Gatzoulis M, Rigby M, Shinebourne E, Redington A . Contemporary results of balloon valvuloplasty and surgical valvotomy for congenital aortic stenosis. Arch Dis Child. 1995; 73(1):66-9. PMC: 1511170. DOI: 10.1136/adc.73.1.66. View

17.

Moore P, Egito E, Mowrey H, Perry S, Lock J, Keane J . Midterm results of balloon dilation of congenital aortic stenosis: predictors of success. J Am Coll Cardiol. 1996; 27(5):1257-63. DOI: 10.1016/0735-1097(95)00608-7. View

18.

McCrindle B . Independent predictors of immediate results of percutaneous balloon aortic valvotomy in children. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry Investigators. Am J Cardiol. 1996; 77(4):286-93. DOI: 10.1016/s0002-9149(97)89395-2. View

19.

Hawkins J, Minich L, Shaddy R, Tani L, Orsmond G, Sturtevant J . Aortic valve repair and replacement after balloon aortic valvuloplasty in children. Ann Thorac Surg. 1996; 61(5):1355-8. DOI: 10.1016/0003-4975(96)00018-5. View

20.

van Son J, Reddy V, Black M, Rajasinghe H, Haas G, Hanley F . Morphologic determinants favoring surgical aortic valvuloplasty versus pulmonary autograft aortic valve replacement in children. J Thorac Cardiovasc Surg. 1996; 111(6):1149-56; discussion 1156-7. DOI: 10.1016/s0022-5223(96)70216-7. View