Advertisement

Pediatric Cardiology

, Volume 39, Issue 8, pp 1554–1560 | Cite as

Comparison of Balloon Dilatation and Surgical Valvuloplasty in Non-critical Congenital Aortic Valvular Stenosis at Long-Term Follow-Up

  • Sezen Ugan Atik
  • Ayşe Güler Eroğlu
  • Betül Çinar
  • Murat Tuğberk Bakar
  • İrfan Levent Saltik
Original Article

Abstract

The two main modalities used for congenital aortic valvular stenosis (AVS) treatment are balloon aortic valve dilatation (BAD) and surgical aortic valvuloplasty (SAV). This study evaluates residual and recurrent stenosis, aortic regurgitation (AR) development/progression, reintervention rates, and the risk factors associated with this end point in patients with non-critical congenital AVS who underwent BAD or SAV after up to 18 years of follow-up. From 1990 to 2017, 70 consecutive interventions were performed in patients with AVS, and 61 were included in this study (33 BADs and 28 SAVs). There were no significant differences in age, sex distribution, PSIG, and AR frequency between the BAD and SAV groups. Bicuspid valve morphology was more common in the BAD group than the SAV group. There was no statistically significant difference between PSIGs and AR development or progression after intervention at the immediate postoperative echocardiography of patients who underwent BAD or SAV (p = 0.82 vs. p = 0.29). Patients were followed 6.9 ± 5.1 years after intervention. The follow-up period in the SAV group was longer than that of the BAD group (9.5 ± 5.4 vs. 5.5 ± 4.4 years, p = 0.003). There was no statistically significant difference in the last echocardiographic PSIG between patients who underwent SAV or BAD (51.1 ± 33.5 vs. 57.3 ± 35.1, p = 0.659). Freedom from reintervention was 81.3% at 5 years and 57.5% at 10 years in the BAD group and 95.5% at 5 years and 81.8% at 10 years in the SAV group, respectively (p = 0.044). There was no difference in postprocedural immediate PSIG and last PSIG at follow-up and the development/progression of AR between patients who were treated with BAD versus SAV. However, long-term results of SAV were superior to those of BAD, with a somewhat prolonged reintervention interval.

Keywords

Aortic valvular stenosis Balloon aortic valve dilatation Echocardiography Surgical aortic valvuloplasty 

Notes

Acknowledgements

No Grant or financial support was used for this research project. No author had any financial interest in the subject matter discussed in the submitted manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Samanek M, Voriskova M (1999) Congenital heart disease among 815,569 children born between 1980 and 1990 and their 15-year survival: a prospective Bohemia survival study. Pediatr Cardiol 20:411–417CrossRefGoogle Scholar
  2. 2.
    Lillehei CW, Dewall RA, Gott VL, Varco RL (1956) The direct vision correction of calcific aortic stenosis by means of a pump-oxygenator and retrograde coronary sinus perfusion. Dis Chest 30:123–132CrossRefGoogle Scholar
  3. 3.
    Lababidi Z (1983) Aortic balloon valvuloplasty. Am Heart J 106:751–752CrossRefGoogle Scholar
  4. 4.
    Brown DW, Dipilato AE, Chong EC et al (2010) Aortic valve reinterventions after balloon aortic valvuloplasty for congenital aortic stenosis intermediate and late follow-up. J Am Coll Cardiol 56:1740–1749CrossRefGoogle Scholar
  5. 5.
    Ewert P, Bertram H, Breuer J et al (2011) Balloon valvuloplasty in the treatment of congenital aortic valve stenosis-a retrospective multicenter survey of more than 1000 patients. Int J Cardiol 149:182–185CrossRefGoogle Scholar
  6. 6.
    d’Udekem Y, Siddiqui J, Seaman CS et al (2013) Long-term results of a strategy of aortic valve repair in the pediatric population. J Thorac Cardiovasc Surg 145:461–467CrossRefGoogle Scholar
  7. 7.
    Hill GD, Ginde S, Rios R et al (2016) Surgical valvuloplasty versus balloon valvuloplasty for congenital aortic valve stenosis: a systematic review and meta-analysis. J Am Heart Assoc 5:e003931CrossRefGoogle Scholar
  8. 8.
    Maskatia SA, Ing FF, Justino H et al (2011) Twenty-five year experience with balloon aortic valvuloplasty for congenital aortic stenosis. Am J Cardiol 108:1024–1028CrossRefGoogle Scholar
  9. 9.
    Thomson JDR (2004) Management of valvar aortic stenosis in children. Heart 90:5–6CrossRefGoogle Scholar
  10. 10.
    Prijic SM, Vukomanovic VA, Stajevic MS, Bjelakovic BB, Zdravkovic MD, Sehic IN, Kosutic JL (2015) Balloon dilation and surgical valvotomy comparison in non-critical congenital aortic valve stenosis. Pediatr Cardiol 36(3):616–624CrossRefGoogle Scholar
  11. 11.
    Donald JS, Konstantinov IE (2016) Surgical aortic valvuloplasty versus balloon aortic valve dilatation in children. World J Pediatr Congenit Heart Surg 7(5):583–591CrossRefGoogle Scholar
  12. 12.
    Cantinotti M, Giordano R, Emdin M et al (2017) Echocardiographic assessment of pediatric semilunar valve disease. Echocardiography 34:1360–1370CrossRefGoogle Scholar
  13. 13.
    Karamlou T, Shen I, Alsoufia B et al (2005) The influence of valve physiology on outcome following aortic valvotomy for congenital bicuspid valve in children: 30 year results from a single institution. Eur J Cardiothorac Surg 27:81–85CrossRefGoogle Scholar
  14. 14.
    Latson LA (1998) Aortic stenosis: valvular, supravalvular, and fibromuscular Subralvular. In: Garson A, Bricker JT, McNamara DG (eds) The science and practice of pediatric cardiology, 2nd edn. Lea & Febiger, Philadelphia, pp 1257–1276Google Scholar
  15. 15.
    Bonow RO, Carabello B, de Leon AC Jr et al (1998) Guidelines for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease. Circulation 98:1949–1984CrossRefGoogle Scholar
  16. 16.
    Zoghbi WA, Enriquez-Sarano M, Foster E, American Society of Echocardiography et al (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional And Doppler echocardiography. J Am Soc Echocardiogr 16:777–802CrossRefGoogle Scholar
  17. 17.
    Nishimura RA, Otto CM, Bonow RO et al (2017) 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation 135:e1159–e1195CrossRefGoogle Scholar
  18. 18.
    Feltes TF, Bacha E, Beekman RH 3rd, American Heart Association Congenital Cardiac Defects Committee of the Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Council on Cardiovascular Radiology and Intervention; American Heart Association et al (2011) Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 123(22):2607–2652CrossRefGoogle Scholar
  19. 19.
    Karamlou T, Shen I, Alsoufia B, Burch G, Reller M, Silberbach M, Ungerleider RM (2005) The influence of valve physiology on outcome following aortic valvotomy for congenital bicuspid valve in children: 30-year results from a single institution. Eur J Cardiothorac Surg 27:81–85CrossRefGoogle Scholar
  20. 20.
    Latiff HA, Sholler GF, Cooper S (2003) Balloon dilatation of aortic stenosis in infants younger than 6 months of age: intermediate outcome. Pediatr Cardiol 24:17–26CrossRefGoogle Scholar
  21. 21.
    Miyamoto T, Sinzobahamvya N, Wetter J et al (2006) Twenty years experience of surgical aortic valvotomy for critical aortic stenosis in early infancy. Eur J Cardiothorac Surg 30(1):35–40CrossRefGoogle Scholar
  22. 22.
    Polimenakos AC, Sathanandam S, Elzein C, Barth MJ, Higgins RS, Ilbawi MN (2010) Aortic cusp extension valvuloplasty with or without tricuspidization in children and adolescents: long-term results and freedom from aortic valve replacement. J Thorac Cardiovasc Surg 139(4):933–941 (discussion 941)CrossRefGoogle Scholar
  23. 23.
    Hraska V, Sinzobahamvya N, Haun C et al (2012) The long-term outcome of open valvotomy for critical aortic stenosis in neonates. Ann Thorac Surg 94(5):1519–1526CrossRefGoogle Scholar
  24. 24.
    Soulatges C, Momeni M, Zarrouk N et al (2015) Long-term results of balloon valvuloplasty as primary treatment for congenital aortic valve stenosis: a 20-year review. Pediatr Cardiol 36(6):1145–1152CrossRefGoogle Scholar
  25. 25.
    Rossi RI, Manica JL, Petraco R, Scott M, Piazza L, Machado PM (2011) Balloon aortic valvuloplasty for congenital aortic stenosis using the femoral and the carotid artery approach: a 16-year experience from a single center. Catheter Cardiovasc Interv 78(1):84–90CrossRefGoogle Scholar
  26. 26.
    d’Udekem Y (2011) Aortic valve surgery in children. Heart 97(14):1182–1189CrossRefGoogle Scholar
  27. 27.
    Siddiqui J, Brizard CP, Galati JC, Iyengar AJ, Hutchinson D, Konstantinov IE, Wheaton GR, Ramsay JM, d’Udekem Y (2013) Surgical valvotomy and repair for neonatal and infant congenital aortic stenosis achieves better results than interventional catheterization. J Am Coll Cardiol 62(22):2134–2140CrossRefGoogle Scholar
  28. 28.
    Gatzoulis MA, Rigby ML, Shinebourne EA, Redington AN (1995) Contemporary results of balloon valvuloplasty and surgical valvotomy for congenital aortic stenosis. Arch Dis Child 73:66–69CrossRefGoogle Scholar
  29. 29.
    Kallio M, Rahkonen O, Mattila I, Pihkala J (2017) Congenital aortic stenosis: treatment outcomes in a nationwide survey. Scand Cardiovasc J 51(5):277–283CrossRefGoogle Scholar
  30. 30.
    McCrindle BW, Blackstone EH, Williams WG et al (2001) Are outcomes of surgical versus transcatheter balloon valvotomy equivalent in neonatal critical aortic stenosis? Circulation 104(12 suppl 1):i152–i158CrossRefGoogle Scholar
  31. 31.
    Justo RN, McCrindle BW, Benson LN, Williams WG, Freedom RM, Smallhorn JF (1996) Aortic valve regurgitation after surgical versus percutaneous balloon valvotomy for congenital aortic valve stenosis. Am J Cardiol 77:1332–1338CrossRefGoogle Scholar
  32. 32.
    Fratz S, Gildein HP, Balling G, Sebening W, Genz T, Eicken A, Hess J (2008) Aortic valvuloplasty in pediatric patients substantially postpones the need for aortic valve surgery: a single-center experience of 188 patients after up to 17.5 years of follow-up. Circulation 117:1201–1206CrossRefGoogle Scholar
  33. 33.
    Brown JW, Rodefeld MD, Ruzmetov M, Eltayeb O, Yurdakok O, Turrentine MW (2012) Surgical valvuloplasty versus balloon aortic dilation for congenital aortic stenosis: are evidence-based outcomes relevant? Ann Thorac Surg 94:146–155CrossRefGoogle Scholar
  34. 34.
    Agnoletti G, Raisky O, Boudjemline Y et al (2006) Neonatal surgical aortic commissurotomy: predictors of outcome and long-term results. Ann Thorac Surg 82(5):1585–1592CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatric Cardiologyİstanbul University Cerrahpaşa Medical FacultyIstanbulTurkey
  2. 2.Department of Pediatricsİstanbul University Cerrahpaşa Medical FacultyIstanbulTurkey
  3. 3.Department of Public Healthİstanbul University Cerrahpaşa Medical FacultyIstanbulTurkey

Personalised recommendations