Article

Aortic Valve Reinterventions After Balloon Aortic Valvuloplasty for Congenital Aortic Stenosis Intermediate and Late Follow-Up

Harvard University, Cambridge, Massachusetts, United States
Journal of the American College of Cardiology (Impact Factor: 15.34). 11/2010; 56(21):1740-9. DOI: 10.1016/j.jacc.2010.06.040
Source: PubMed

ABSTRACT the aim of this study was to evaluate the long-term results of transcatheter balloon aortic valvuloplasty, the preferred treatment for congenital aortic stenosis (AS).
aortic valve function and reintervention late after this procedure are not well characterized.
from 1985 to 2008, 563 patients underwent balloon dilation for congenital AS. After excluding those converted to univentricular circulation and/or died ≤ 30 days after the procedure, 509 patients constituted the study cohort.
The median follow-up period was 9.3 years (range 0.1 to 23.6 years); cumulative follow-up was 5,003 patient-years. The median age was 2.4 years (range 1 day to 40.5 years), and most patients (73%) had isolated native AS. Peak AS gradients decreased significantly after dilation (median decrease, 35 mm Hg), and acute post-dilation aortic regurgitation was moderate or greater in 70 patients (14%). Older patients more often had post-dilation aortic regurgitation (p < 0.001). During follow-up, 225 patients (44%) underwent aortic valve reintervention: repeat balloon dilation in 115 (23%), aortic valve repair in 65 (13%), and aortic valve replacement in 116 (23%). Survival free from any aortic valve reintervention was 89 ± 1% at 1 year, 72 ± 2% at 5 years, 54 ± 3% at 10 years, and 27 ± 3% at 20 years. Freedom from aortic valve replacement was 90 ± 2% at 5 years, 79 ± 3% at 10 years, and 53 ± 4% at 20 years. In multivariate analyses, lower post-dilation AS gradient and lower grade of post-dilation aortic regurgitation were associated with longer freedom from aortic valve replacement, but age, era, and pre-dilation AS severity were not.
although transcatheter aortic valvuloplasty is effective for relief of congenital AS, there are steady long-term hazards for surgical aortic valve reintervention and replacement that are independent of age at initial intervention or AS severity.

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    • "The long-term results of balloon valvuloplasty in children are good. Currently, survival reaches 95%, 89-93% and 81-88% after 5, 10 and 20 years, respectively [28, 29]. In a multicenter analysis of 1004 patients Ewert et al. [22] demonstrated that 50% of children with congenital aortic valve stenosis treated with this method do not require surgical aortic valve replacement within 10 years after the procedure and that 90% of them remain in good clinical condition with normal left ventricular function during that period. "
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    • "Deux études rétrospectives évaluant le devenir à long terme des patients traités par valvuloplastie percutané ont récemment été publiée, l'une multicentrique portant sur plus de 1 000 enfants répartis en trois tranches d'âge, et une étude monocentrique américaine de 563 patients [15] [16]. Les patients orientés vers une stratégie de réparation univentriculaire dans le premier mois ont été exclus de ces études. "
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