Balloon dilatation versus surgical valvotomy for congenital aortic stenosis: a propensity score matched study

2021 ◽  
pp. 1-7
Author(s):  
Benjamin C. Auld ◽  
Julia S. Donald ◽  
Naychi Lwin ◽  
Kim Betts ◽  
Nelson O. Alphonso ◽  
...  
Keyword(s):  
Propensity Score ◽  
Aortic Stenosis ◽  
Left Ventricular ◽  
Balloon Valvuloplasty ◽  
Congenital Aortic Stenosis ◽  
Children's Hospital ◽  
Significant Difference ◽  
Children’S Hospital ◽  
Surgical Group

Abstract Background: Balloon valvuloplasty and surgical aortic valvotomy have been the treatment mainstays for congenital aortic stenosis in children. Choice of intervention often differs depending upon centre bias with limited relevant, comparative literature. Objectives: This study aims to provide an unbiased, contemporary matched comparison of these balloon and surgical approaches. Methods: Retrospective analysis of patients with congenital aortic valve stenosis who underwent balloon valvuloplasty (Queensland Children’s Hospital, Brisbane) or surgical valvotomy (Royal Children’s Hospital, Melbourne) between 2005 and 2016. Patients were excluded if pre-intervention assessment indicated ineligibility to either group. Propensity score matching was performed based on age, weight, and valve morphology. Results: Sixty-five balloon patients and seventy-seven surgical patients were included. Overall, the groups were well matched with 18 neonates/25 infants in the balloon group and 17 neonates/28 infants in the surgical group. Median age at balloon was 92 days (range 2 days – 18.8 years) compared to 167 days (range 0 days – 18.1 years) for surgery (rank-sum p = 0.08). Mean follow-up was 5.3 years. There was one late balloon death and two early surgical deaths due to left ventricular failure. There was no significant difference in freedom from reintervention at latest follow-up (69% in the balloon group and 70% in the surgical group, p = 1.0). Conclusions: Contemporary analysis of balloon aortic valvuloplasty and surgical aortic valvotomy shows no difference in overall reintervention rates in the medium term. Balloon valvuloplasty performs well across all age groups, achieving delay or avoidance of surgical intervention.

scholarly journals Effect of persistence of left ventricular hypertrophy and left atrial dilatation after aortic valve replacement on early outcomes and survival: a prospective study

2019 ◽  
Vol 6 (10) ◽  
pp. 3786
Author(s):  
Hari Krishna Murthy P. ◽  
Abha Chandra
Keyword(s):  
Aortic Valve ◽  
Left Ventricular Hypertrophy ◽  
Aortic Stenosis ◽  
Left Atrial ◽  
Ventricular Hypertrophy ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Significant Difference ◽  
A Prospective Study

Background: The objective of the study was to evaluate the early outcomes and survival in patients with severe aortic stenosis associated with concentric left ventricular hypertrophy following aortic valve replacement.Methods: This is a prospective study done at SVIMS, Tirupati, from June 2014 to September 2015 evaluating out comes and survival in patients undergoing primary isolated aortic valve replacement (AVR) for severe aortic stenosis, severe aortic stenosis with mild aortic regurgitation and severe aortic stenosis with moderate aortic regurgitation.Results: A total of 40 cases 26 males and 14 females aged 18 to 60 years (mean age, 48.5±13.4 years) underwent elective AVR. Left ventricular end diastolic diameter (p=0.008) at 6 months, a statistically highly significant difference in left ventricular mass  preoperatively, at discharge, at 3rd and 6th month follow up. The difference in mean left ventricular mass index (LVMI) had declined from 244.425 to 141.100 at 6 months, showing a statistically highly significant difference in LVMI preop, at discharge, at 3rd month and at 6th month follow up.Conclusions: Patients with preoperative increase in LVMI, with large left atrial diameter carries a strong predictor of postoperative mortality for patients undergoing aortic valve surgery. We also conclude that there will be significant regression of LVMI following successful AVR. But, the decrease in LVMI is maximum during early three months and it is minimal though significant in the later course of follow up. 

scholarly journals Balloon Valvuloplasty for Congenital Aortic Stenosis: Experience at a Tertiary Center in a Developing Country

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Fatme A. Charafeddine ◽  
Haytham Bou Houssein ◽  
Nadine B. Kibbi ◽  
Issam M. El-Rassi ◽  
Anas M. Tabbakh ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Developing Country ◽  
Aortic Regurgitation ◽  
Developed Countries ◽  
Left Ventricular ◽  
Complication Rates ◽  
Congenital Aortic Stenosis ◽  
Tertiary Center

Background. Aortic valve stenosis accounts for 3–6% of congenital heart disease. Balloon aortic valvuloplasty (BAV) is the preferred therapeutic intervention in many centers. However, most of the reported data are from developed countries. Materials and Methods. We performed a retrospective single-center study involving consecutive eligible neonates and infants with congenital aortic stenosis admitted for percutaneous BAV between January 2005 and January 2016 to our tertiary center. We evaluated the short- and mid-term outcomes associated with the use of BAV as a treatment for congenital aortic stenosis (CAS) at a tertiary center in a developing country. Similarly, we compared these outcomes to those reported in developed countries. Results. During the study period, a total of thirty patients, newborns (n = 15) and infants/children (n = 15), underwent BAV. Left ventricular systolic dysfunction was present in 56% of the patients. Isolated AS was present in 19 patients (63%). Associated anomalies were present in 11 patients (37%): seven (21%) had coarctation of the aorta, two (6%) had restrictive ventricular septal defects, one had mild Ebstein anomaly, one had Shone’s syndrome, and one had cleft mitral valve. BAV was not associated with perioperative or immediate postoperative mortality. Immediately following the valvuloplasty, a more than mild aortic regurgitation was noted only in two patients (7%). A none-to-mild aortic regurgitation was noted in the remaining 93%. One patient died three months after the procedure. At a mean follow-up of 7 years, twenty patients (69%) had more than mild aortic regurgitation, and four patients (13%) required surgical intervention. Kaplan–Meier freedom from aortic valve reintervention was 97% at 1 year and 87% at 10 years of follow-up. Conclusion. Based on outcomes encountered at a tertiary center in a developing country, BAV is an effective and safe modality associated with low complication rates comparable to those reported in developed countries.

Survival of patients with moderate aortic stenosis: propensity score matching analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Itelman ◽  
O Vatury ◽  
S Ben-Zekry ◽  
R Kuperstein ◽  
P Fefer ◽  
...  
Keyword(s):  
Propensity Score ◽  
Aortic Stenosis ◽  
Propensity Score Matching ◽  
Interaction Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cumulative Probability ◽  
Current Analysis ◽  
Ventricular Ejection Fraction

Abstract Introduction and purpose Data on the survival of patients with moderate aortic stenosis (AS) is conflicting. The purpose of the current analysis was to assess survival of moderate AS patients. Methods SHARE is an historical retrospective cohort of all cardiovascular patients evaluated in an Israeli tertiary hospital between 2007 and 2019. The current analysis included all patients who underwent echocardiographic evaluation. Aortic stenosis severity was extracted for all patients from the echocardiographic reports. All-cause mortality and was available for all patients. Subjects with severe AS or aortic valve replacement were excluded from the analysis. Results Cohort included 97,561 subjects of whom 42,187 (43.2%) were outpatients. Final cohort included 93,889 patients with a mean age of 66±17 (58% men). There were 2,949 (3%) with moderate AS. During a median follow up of 52 [IQR 22–89] months 17,173 (18%) patients died. Kaplan-Meier survival analysis demonstrated worse cumulative probability of death of 51%±2% vs. 20%±0% at 5 years for patients with moderate AS vs. mild or no AS, respectively (p Log rank <0.001). Sub-analysis of 32,745 patients for whom clinical laboratory and medication data was available yielded consistent results in a comprehensive multivariate model such that patients with moderate AS (N=1,381) were 26% more likely to die (95% CI: 1.17–1.37, p<0.0001). Finally, a propensity score matching of patients with moderate AS and controls with no or mild AS (N=1,381) successfully demonstrated that patients with moderate AS were 40% more likely to die during follow up (95% CI 1.25–1.57, p<0.001; FIGURE). Four-years mortality rates were 2 fold higher for patients with moderate AS compared with controls (OR = 1.96, 95% CI 1.6–2.4, p<0.001). Interaction analysis demonstrated that the association of moderate AS with survival was not dependent on left ventricular ejection fraction. Conclusion Moderate AS is associated with worse survival. Our findings underscore the importance of careful clinical observation as well as the need for further studies. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Balloon Valvuloplasty of Aortic Valve Stenosis in Childhood: Midterm Results in a Children's Hospital, Mansoura University, Egypt

2012 ◽  
Vol 6 ◽  
pp. CMC.S8602 ◽  
Author(s):  
Hala Al Marshafawy ◽  
Gehan Attia Al Sawah ◽  
Mona Hafez ◽  
Mohammed Matter ◽  
Adel El Gamal ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Femoral Artery ◽  
Early Death ◽  
Balloon Valvuloplasty ◽  
Lv Function ◽  
Midterm Results ◽  
Children's Hospital ◽  
Children’S Hospital

Background Balloon valvuloplasty was established as an alternative to surgery for treatment of aortic valve stenosis in childhood. Acute complications after balloon dilatation including aortic insufficiency or early death were described. Aim of Work To analyze early outcome and midterm results of balloon aortic valvuloplasty (BAV) in Children's Hospital, Mansoura University, Egypt. Subjects and Methods Between April 2005–June 2008, all consecutive patients of age <18 years treated for aortic valve stenosis (AVS) with BAV were analyzed retrospectively. The study included 21 patients; 17 males, and 4 females. Their age ranged from the neonatal period to 10 years (mean age 5.6 ± 3.7 years). Patients with gradient ≥50 mmHg and aortic valve insufficiency (AI) up to grade I were included. All patients had isolated aortic valve stenosis except 3 patients (14.3%) had associated aortic coarctation. Six patients (28.6%) had bicuspid aortic valve. All patients had normal myocardial function except one (4.8%) had FS 15%. The duration of follow up was (mean ± SD: 18.5 ± 11.7 months). Results Femoral artery approach was used in 20 patients (95.2%) and carotid artery in one neonate (4.8%). Balloon/annulus ratio was 0.83 ± 0.04. Significant reduction in pressure gradient was achieved (mean 66.7 ± 9.8 mmHg to 20.65 ± 2.99 mmHg) ( P < 0.001). Nine patients (42.8%) developed grade I AI, 2 patients (9.5%) developed grade II AI and 1 patient (4.8%) developed grade III AI. Two early deaths (9.5%); one died due to heart failure caused by grade IV AI and a neonate died because of severely compromised LV function. One patient (4.8%) had femoral artery occlusion necessitating anticoagulation. Patients remained free from re-intervention during follow up. Conclusion Balloon valvuloplasty of aortic valve stenosis significantly reduces gradient with low morbidity and mortality in children.

scholarly journals Balloon valvuloplasty as a treatment of congenital aortic stenosis in children and adolescents

2014 ◽  
Vol 142 (1-2) ◽  
pp. 17-22 ◽  
Author(s):  
Vojislav Parezanovic ◽  
Milan Djukic ◽  
Ingo Daehnert ◽  
Ana Gligic ◽  
Igor Stefanovic ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Children And Adolescents ◽  
Valve Replacement ◽  
Interventional Procedure ◽  
Balloon Valvuloplasty ◽  
Primary Therapy ◽  
Congenital Aortic Stenosis

Introduction. Balloon valvuloplasty (BVP) is one of the primary therapies for congenital aortic stenosis in children and adolescents. The aim of this interventional procedure is to gain time before possible surgical therapy (aortic valve replacement) until adulthood. Objective. The aim of this study was to evaluate the efficacy, safety and mid-term results of transcatheter BVP in children and adolescent in our Center. Methods. From 2004 to 2011, 50 patients, aged 18 days to 18 years (mean 6.3 years) underwent BVP. Retrospective analysis of the echocardiographic and hemodynamic parameters were performed before and after procedure, especially peak pressure gradient (PG) across the aortic valve, semiquantification of the aortic regurgitation (AR) after the BVP as well as the left ventricle dimensions and functions. Results. The mean peak PG in the whole group decreased from 74.80?27.72 mm Hg to 27.86?13.04 mm Hg (p<0.001) after BVP. In 39 patients (78%), residual PG was lower than 30 mm Hg just after dilation. At the end of follow-up period, 25 patients (50%) had PG above 50 mm Hg, measured by Doppler technique, and four of them underwent re-dilation. Eight patients (16%) had severe AR. During the follow-up period (12-80 months, mean 51 months), six patients (12%) were referred to cardiac surgeons for aortic valve replacement or Ross procedure. Conclusions. This retrospective study analyzes our first experience of BVP as primary therapy of the congenital aortic stenosis. The results confirmed that BVP effectively postponed the need for surgery in children and adolescents toward the adulthood.

Surgical and Transcatheter Treatments in Children with Congenital Aortic Stenosis

2020 ◽  
Author(s):  
Yifan Zhu ◽  
Renjie Hu ◽  
Wen Zhang ◽  
Xiafeng Yu ◽  
Wei Dong ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Aortic Stenosis ◽  
Balloon Dilation ◽  
Early Death ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Congenital Aortic Stenosis ◽  
Significant Difference ◽  
Congenital Aortic Valve Stenosis ◽  
Peak Gradient

Abstract Background For patients with congenital aortic valve stenosis (AVS), comprehensive analysis of surgical aortic valvuloplasty (SAV) or balloon dilation (BD) is scarce and remains controversial. Methods This study reviewed AVS data (aortic peak gradient, aortic insufficiency, and survival and reoperation) for patients who were suitable for biventricular repair at our center in 2008 to 2018. Patients were categorized into two subgroups based on age (≤3 or >3 months). Results A total of 194 patients were treated, including 124 with SAV and 70 with BD. Resulting data revealed that residual aortic gradient at discharge was worse for BD (p = 0.001). While for patients younger than 3 months, the relief of AVS was comparable between the two groups (p = 0.624). There was no significant difference in time-related survival between the two groups (log-rank p = 0.644). Multivariate analysis demonstrated that preoperative left ventricular end-diastolic dimension predicted early death (p = 0.045). Survival in the two groups after 10 years was 96.8% in SAV and 95.7% in BD (p = 0.644). Freedom from reoperation after 10 years was 58.1% in SAV and 41.8% in BD patients (p = 0.01). There was no significant difference in freedom from reoperation between SAV and BD in patients younger than 3 months (p = 0.84). Multivariate analysis indicated that residual aortic peak gradient was predictive of reoperation (p = 0.038). Conclusion Both methods achieved excellent survival outcomes at our center. SAV achieved superior gradient reduction and minimized the necessity for reoperation. For patients younger than 3 months, BD rivaled SAV both in aortic stenosis relief and freedom from reoperation.

Echocardiographic findings on aortic stenosis: an observational, prospective, and multi-center registry

Perfusion ◽  
2020 ◽  
pp. 026765912092492
Author(s):  
Shehab Anwer ◽  
Didem Oğuz ◽  
Laura Galian-Gay ◽  
Irena Peovska Mitevska ◽  
Lilit Baghdassarian ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Right Ventricular ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Low Flow ◽  
Aortic Valve Area ◽  
Significant Difference

Background: The aim of this aortic stenosis registry was to investigate the changes of routine echocardiographic indices and strain in patients with moderate-to-severe aortic stenosis over a 6-month follow-up period. Methods: Our aortic stenosis registry is observational, prospective, multicenter registry of nine countries, with 197 patients with aortic valve area less than 1.5 cm2. The enrolment took place from January to August 2017. We excluded patients with uncontrolled atrial arrhythmias, pulmonary hypertension or cardiomyopathies, as well as those with hemodynamically significant valvular disease other than aortic stenosis. We included patients who did not require intervention and who had a complete follow-up study. Results: In patients with preserved ejection fraction, left ventricular mass has significantly increased between baseline and follow-up studies (218 ± 34 grams vs 253 ± 29 grams, p = 0.02). However, when indexed to body surface area, there was no significant difference. Left ventricular global longitudinal strain significantly decreased (-19.7 ± -4.8 vs (-16.4 vs -3.8, p = 0.01). Left atrial volume was significantly higher at follow-up (p = 0.035). Right ventricular basal diameter and mid-cavity diameter were greater at the follow-up (p = 0.04 and p = 0.035, respectively). Patients with low-flow low-gradient aortic stenosis had significantly lower global longitudinal strain (-12.3% ± -3.9% vs -19.7% ± -4.8%, p = 0.01). Conclusion: Left atrial dilatation is one of the first changes to take place in low-flow low-gradient aortic stenosis patients even when left ventricular dimensions and function remains intact. Global longitudinal strain is an important determinant of left ventricular systolic and diastolic dysfunction and right ventricular function is an important parameter of aortic stenosis assessment. Accordingly, our registry has further shed the light on these indices role as multisite follow-up of aortic stenosis.

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