Percutaneous balloon dilatation for congenital aortic stenosis during infancy: A 15-years single-center experience

Abstract

Introduction: The aim of this study was to identify factors predictive of reintervention following balloon aortic valvuloplasty (BAV) for congenital aortic stenosis (AS) during infancy. Methodology: Retrospectively, patients with congenital AS who required BAV in the first year of life between 2001 and 2016 were included. Patients who required direct surgical intervention were excluded. Echocardiography (echo) and cardiac catheterization (cath) data were analyzed. Response ratio (RR) was defined as the ratio between the drop in aortic valve (AV) peak gradient to the baseline peak gradient. Follow-ups and the need for reintervention were documented. Results: A total of 60 infants were included. Sixteen patients (27%) were newborns. The average peak-to-peak gradient from the left ventricle to the ascending aorta was 64 ± 27 mmHg, which was reduced to an average of 27 ± 13 mmHg. Average response ratio was 53 ± 24%. None of the patients had a significant aortic insufficiency (AI) before procedure, while 6 (10%) had significant AI immediately after BAV. Fourteen patients (23%) required an additional BAV. They had low cath-RR of 39 ± 27 and echo-RR of 15 ± 33 versus those who had BAV once with ratios of 60 ± 17 (cath; p = 0.002) and 36 ± 28 (echo; p = 0.025) during the initial intervention. Eight patients (13.3%) required surgical interventions following BAV. They had small AV to pulmonary valve (PV) ratios (p = 0.029) and higher residual AV gradients (p < 0.001). Mortality was 8.3%. Conclusion: Balloon valvuloplasty in infancy resulted in a high rate of reintervention and mortality. The response ratios were useful for predicting the future need of an additional BAV, and the AV/PV ratio and AV residual gradient were more predictive of the need for surgical intervention.