Surgical Valvotomy and Repair for Neonatal and Infant Congenital Aortic Stenosis Achieves Better Results Than Interventional Catheterization

• Published in: Journal of the American College of Cardiology Vol. 62; no. 22; pp. 2134 - 2140
• Main Authors: Siddiqui, Javariah, MBBS, Brizard, Christian P., MD, Galati, John C., PhD, Iyengar, Ajay J., MBBS, Hutchinson, Darren, MD, Konstantinov, Igor E., MD, PhD, Wheaton, Gavin R., MD, Ramsay, James M., MD, d'Udekem, Yves, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 03.12.2013; Elsevier; Elsevier Limited
• Subjects: Age; Angioplasty, Balloon; Aortic Coarctation - epidemiology; aortic valve; Aortic Valve - surgery; Aortic Valve Stenosis - congenital; Aortic Valve Stenosis - epidemiology; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Aortic Valve Stenosis - therapy; Balloon Valvuloplasty; Biological and medical sciences; Cardiac Surgical Procedures; Cardiology; Cardiology. Vascular system; Cardiovascular; Comorbidity; congenital heart disease; Defects; Endocardial Fibroelastosis - epidemiology; Female; Heart; Heart failure; Heart Failure - epidemiology; Hospital Mortality; Hospitals; Humans; Infant; Infant, Newborn; Internal Medicine; Intervention; Intubation; Male; Medical sciences; Mitral Valve Stenosis - epidemiology; Mortality; Multivariate Analysis; Retrospective Studies; Statistical analysis; Studies; Surgery; Surgical techniques; Treatment Outcome; congenital heart disease; aortic valve; balloon valvuloplasty; balloon valv; surgery; Human; Aortic stenosis; Corrective surgery; Neonatal; Valvulotomy; Catheterization; Congenital; Infant; Cardiovascular disease; Congenital disease; Result; Newborn; Treatment; Circulatory system; Cardiology; Repair
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2013.07.052

Objectives This study sought to compare outcomes after surgical valvuloplasty and balloon dilation of the aortic valve in neonates and infants. Background Surgical techniques of aortic valve repair have improved and there is today controversy on the best approach to treat neonatal congenital aortic valve stenosis. Methods Retrospective review of data and follow-up of 123 consecutive neonates and infants (35 females, 88 males) undergoing intervention for congenital aortic stenosis. Results From 1977 to 2009, 123 consecutive neonates (<30 days) and infants (31 days to 1 year) underwent relief of congenital aortic stenosis. Median age at procedure was 27 days (6 to 76 days). Twenty-year survival was 80 ± 7%. Fifty-four patients required a re-intervention and freedom from re-intervention was 55 ± 6% at 10 years and 40 ± 6% at 20 years. By multivariate analysis, having the relief of stenosis by balloon valvuloplasty and undergoing initial treatment as a neonate were predictive of re-intervention. Freedom from re-intervention at 5 years was 27% after balloon valvuloplasty versus 65% after surgery. At latest follow-up, an additional 16 patients had moderate or severe stenosis and 8 had regurgitation. Freedom from re-intervention or stenosis was 39 ± 5% at 15 years. By multivariate analysis, balloon valvuloplasty (p < 0.001) and treatment as a neonate (p = 0.003) were again predictive of stenosis or re-intervention. Thirty-five patients ultimately needed a valve replacement. Significant predictor of the requirement of valve replacement was unicuspid aortic valve (p < 0.001). Freedom from valve replacement was 55 ± 7% at 20 years. Conclusions Surgical valvuloplasty remains the best approach to treat neonates and infants with congenital aortic stenosis. After surgery, a higher proportion of patients remain free of re-intervention than after interventional catheterization and the relief of their stenosis lasts longer.