JACC: Long-term surgical risks surface after pediatric valvuloplasty

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While transcatheter balloon aortic valvuloplasty is effective for treating congenital aortic stenosis (AS), long-term risks for surgical aortic valve reinterventions and replacement still exists, according to a study published Nov. 16 in the Journal of the American College of Cardiology.

To evaluate the long-term results of transcatheter balloon aortic valvuloplasty as a treatment for congenital AS, David W. Brown, MD, of the Harvard Medical School in Boston, and colleagues assessed 563 patients who underwent balloon dilation for congenital AS between 1985 to 2008. Of those patients, 54 were excluded from participation due to univentricular circulation and/or death, leaving 509 patients enrolled.

Patients had a median age of 2.4 years and 73 percent had isolated native AS. Older patients had higher rates of post-dilation aortic regurgitation and the mean duration of follow-up was 9.3 years.

Forty-four patients died during follow-up, and survival over time was 95 percent at five years, 93 percent at 10 years and 88 percent at 20 years.

During follow-up, 225 patients underwent aortic valve reintervention: 115 repeat balloon dilations, 65 aortic valve repairs and 116 aortic valve replacements.

Survival with freedom from any aortic valve reinterventions was 89 percent, 72 percent, 54 percent, 38 percent and 27 percent at one year, five years, 10 years, 15 years and 20 years, respectively.

A total of 149 repeat balloon aortic valve dilations were performed in 115 patients. Freedom from repeat balloon valvuloplasty was 90 percent at one year, 82 percent at five years, 71 percent at 10 years and 63 percent at 20 years.

Forty-nine of the 159 patients who underwent surgical interventions on the aortic valve underwent second balloon dilations before aortic valve surgery. Survival free from any surgical aortic valve reintervention was 82 percent, 69 percent, 58 percent and 45 percent at five years, 10 years, 15 years and 20 years, respectively.

“There was an ongoing steady hazard for AVR [aortic valve replacement] that was not associated with year or era of intervention, resulting in a freedom from AVR of 79 percent at 10 years and 55 percent at 20 years,” the authors noted. “These findings confirm that patients who undergo balloon dilation for AS, regardless of age, AS severity, or associated interventions, are at ongoing risk for AVR, a finding that should inform the clinical care of such patients before and after treatment of congenital AS.

“Although neonates are at higher risk for repeat balloon dilation, they are at no higher risk for AVR than older patients. These findings should inform counseling and evaluation of patients before and after treatment of congenital AS,” the authors concluded.