Repeat balloon aortic valvuloplasty effectively delays surgical intervention in children with recurrent aortic stenosis

Authors

  • Christopher J. Petit MD,

    Corresponding author
    • Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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  • Shiraz A. Maskatia MD,

    1. Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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  • Henri Justino MD,

    1. Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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  • Raphael J. Mattamal BA,

    1. Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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  • Matthew A. Crystal MD,

    1. Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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  • Frank F. Ing MD

    1. Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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  • Conflict of interest: Nothing to report.

Correspondence to: Christopher J. Petit, MD, Emory University School of Medicine, Children's Healthcare of Atlanta, 2835 Brandywine Rd, Ste 300. Atlanta Georgia 30341. E-mail: cjpetit@emory.edu

Abstract

Objective

Balloon aortic valvuloplasty (BAV) is the primary therapy for congenital aortic stenosis (AS). Recurrent AS following initial BAV or initial surgical valvotomy (SV) may require a second BAV (BAV2). We sought to determine the longterm outcomes of BAV2.

Design

We reviewed all cases of BAV2, defined as BAV following primary BAV or SV between 1988 and 2009. Cases were reviewed for pre- and post-BAV2 echocardiographic and procedural details.

Setting

Tertiary care dedicated children's hospital.

Patients

Between 1985 and 2009, 43 patients underwent BAV2 (23 primary SV, 20 primary BAV) at median age 1.9 years (1 month–21 years) and median weight 15 (3.3–55) kg.

Interventions

BAV2 performed following primary SV or primary BAV. Main Outcome

Measures

We evaluated the following endpoints: ≥ moderate AI post-BAV2, aortic valve replacement (AVR), additional BAV or SV post-BAV2, death and heart transplantation.

Results

The gradient decreased from 61.4 ± 16.0 mm Hg to 26.0 ± 13.6 post-BAV2 (P < 0.01). Gradient prior to BAV2 was higher in primary SV patients (66 ± 13 mm Hg) than in primary BAV patients (56 ± 18 mm Hg, P = 0.04). 24 patients had no further events after BAV2, while 19 patients (44%) experienced 23 events including: AVR (n = 8), SV (n = 6), BAV3 (n = 2), death (n = 5), and transplant (n = 1). Regression demonstrated that adverse events were associated with higher post-BAV2 gradient (P < 0.01). Repeat intervention on the aortic valve and AVR were associated with higher post BAV2 gradient (P = 0.04, P = 0.01). Prior to BAV2, 7 patients (17%) had AI > mild, compared to 21 (51%) patients after BAV2. Cox regression revealed that primary BAV was associated with development of AI > mild after BAV2 (P < 0.01).

Conclusion

BAV2 is associated with decreased valve gradient, though with an increase in AI. However, residual AS, not AI, is associated with poor outcomes following BAV2. BAV2 effectively treats recurrent AS and postpones need for surgical intervention. © 2013 Wiley Periodicals, Inc.

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