Balloon valvuloplasty for congenital aortic stenosis: Multi-center safety and efficacy outcome assessment. Catheter Cardiovasc Interv 2015 Nov;86(5):808-20
Date
06/03/2015Pubmed ID
26032565DOI
10.1002/ccd.25969Scopus ID
2-s2.0-84945436936 (requires institutional sign-in at Scopus site) 47 CitationsAbstract
OBJECTIVE: To describe contemporary outcomes of balloon aortic valvuloplasty (BAVP) performed in 22 US centers.
BACKGROUND: BAVP constitutes first-line therapy for congenital aortic stenosis (cAS) in many centers.
METHODS: We used prospectively-collected data from two active, multi-institutional, pediatric cardiac catheterization registries. Acute procedural success was defined, for purposes of this review, as a residual peak systolic gradient≤35 mm Hg and no more than mild aortic regurgitation (AR) for patients with isolated cAS. For patients with mixed aortic valve disease, a residual peak systolic gradient≤35 mm Hg without worsening of AR was considered successful outcome.
RESULTS: In 373 patients with a median age of 8 months (1 day to 40 years of age) peak systolic gradient had a median of 59 [50, 71] mm Hg pre-BAVP and 22 [15, 30] mm Hg post-BAVP (P<0.001). Procedural success was achieved in 160 patients (71%). The factors independently associated with procedural success were: first time intervention (OR=2.0 (1.0, 4.0) P=0.04), not-prostaglandin dependent, (OR=3.5 (1.5, 8.1); P=0.003), and isolated cAS (absence of AR) (OR=2.1 (1.1-3.9); P=0.03). Twenty percent of patients experienced adverse events, half of which were of high severity. There was no procedural mortality. Neonatal status was the only factor associated with increased risk of high severity adverse events (OR 3.7; 95% CI 1.5-9.0).
CONCLUSION: In the current era, BAVP results in procedural success (gradient reduction with minimal increase in AR) in 71% of patients treated at US centers where BAVP is considered first-line therapy relative to surgery.
Author List
Torres A, Vincent JA, Everett A, Lim S, Foerster SR, Marshall AC, Beekman RH 3rd, Murphy J, Trucco SM, Gauvreau K, Holzer R, Bergersen L, Porras DAuthor
Susan Foerster MD Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aortic Valve
Aortic Valve Stenosis
Balloon Valvuloplasty
Chi-Square Distribution
Child
Child, Preschool
Female
Hemodynamics
Humans
Infant
Infant, Newborn
Logistic Models
Male
Odds Ratio
Prospective Studies
Recovery of Function
Registries
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
United States
Young Adult
