Alejandro Torres1, Julie A Vincent1, Allen Everett2, Scott Lim3, Susan R Foerster4, Audrey C Marshall5, Robert H Beekman6, Joshua Murphy7, Sara M Trucco8, Kimberlee Gauvreau5, Ralf Holzer9, Lisa Bergersen5, Diego Porras5. 1. Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York Presbyterian, New York, New York. 2. Division of Pediatric Cardiology, Johns Hopkins University, Baltimore, Maryland. 3. Division of Pediatric Cardiology, University of Virginia, Charlottesville, Virginia. 4. Division of Pediatric Cardiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin. 5. Department of Cardiology, Boston Children's Hospital, Boston Massachusetts, Children's Hospital Boston, Boston, Massachusetts. 6. Division of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 7. Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri. 8. Division of Pediatric Cardiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania. 9. Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, Ohio.
Abstract
OBJECTIVE: To describe contemporary outcomes of balloon aortic valvuloplasty (BAVP) performed in 22 US centers. BACKGROUND: BAVP constitutes first-line therapy for congenital aortic stenosis (cAS) in many centers. METHODS: We used prospectively-collected data from two active, multi-institutional, pediatric cardiac catheterization registries. Acute procedural success was defined, for purposes of this review, as a residual peak systolic gradient≤35 mm Hg and no more than mild aortic regurgitation (AR) for patients with isolated cAS. For patients with mixed aortic valve disease, a residual peak systolic gradient≤35 mm Hg without worsening of AR was considered successful outcome. RESULTS: In 373 patients with a median age of 8 months (1 day to 40 years of age) peak systolic gradient had a median of 59 [50, 71] mm Hg pre-BAVP and 22 [15, 30] mm Hg post-BAVP (P<0.001). Procedural success was achieved in 160 patients (71%). The factors independently associated with procedural success were: first time intervention (OR=2.0 (1.0, 4.0) P=0.04), not-prostaglandin dependent, (OR=3.5 (1.5, 8.1); P=0.003), and isolated cAS (absence of AR) (OR=2.1 (1.1-3.9); P=0.03). Twenty percent of patients experienced adverse events, half of which were of high severity. There was no procedural mortality. Neonatal status was the only factor associated with increased risk of high severity adverse events (OR 3.7; 95% CI 1.5-9.0). CONCLUSION: In the current era, BAVP results in procedural success (gradient reduction with minimal increase in AR) in 71% of patients treated at US centers where BAVP is considered first-line therapy relative to surgery.
OBJECTIVE: To describe contemporary outcomes of balloon aortic valvuloplasty (BAVP) performed in 22 US centers. BACKGROUND: BAVP constitutes first-line therapy for congenital aortic stenosis (cAS) in many centers. METHODS: We used prospectively-collected data from two active, multi-institutional, pediatric cardiac catheterization registries. Acute procedural success was defined, for purposes of this review, as a residual peak systolic gradient≤35 mm Hg and no more than mild aortic regurgitation (AR) for patients with isolated cAS. For patients with mixed aortic valve disease, a residual peak systolic gradient≤35 mm Hg without worsening of AR was considered successful outcome. RESULTS: In 373 patients with a median age of 8 months (1 day to 40 years of age) peak systolic gradient had a median of 59 [50, 71] mm Hg pre-BAVP and 22 [15, 30] mm Hg post-BAVP (P<0.001). Procedural success was achieved in 160 patients (71%). The factors independently associated with procedural success were: first time intervention (OR=2.0 (1.0, 4.0) P=0.04), not-prostaglandin dependent, (OR=3.5 (1.5, 8.1); P=0.003), and isolated cAS (absence of AR) (OR=2.1 (1.1-3.9); P=0.03). Twenty percent of patients experienced adverse events, half of which were of high severity. There was no procedural mortality. Neonatal status was the only factor associated with increased risk of high severity adverse events (OR 3.7; 95% CI 1.5-9.0). CONCLUSION: In the current era, BAVP results in procedural success (gradient reduction with minimal increase in AR) in 71% of patients treated at US centers where BAVP is considered first-line therapy relative to surgery.
Authors: Ali A Alakhfash; Ali Jelly; Abdulrahman Almesned; Abdullah Alqwaiee; Mansour Almutairi; Sherif Salah; Mahmoud Hasan; Mustafa Almuhaya; Abdulhamid Alnajjar; Mohammed Mofeed; Bana Nasser Journal: J Saudi Heart Assoc Date: 2020-05-12
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