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.

Surgical Valvuloplasty Versus Balloon Dilation for Congenital Aortic Stenosis in Pediatric Patients

2020 ◽  
Vol 11 (4) ◽  
pp. 444-451 ◽  
Author(s):  
Jeremy L. Herrmann ◽  
Aaron J. Clark ◽  
Cameron Colgate ◽  
Mark D. Rodefeld ◽  
Mark H. Hoyer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Balloon Dilation ◽  
Aortic Insufficiency ◽  
Term Survival ◽  
Old Patients ◽  
Congenital Aortic Stenosis ◽  
Kaplan Meier ◽  
Aortic Valvuloplasty

Background: For children with congenital aortic stenosis (AS) who are candidates for biventricular repair, valvuloplasty can be achieved by surgical aortic valvuloplasty (SAV) or by transcatheter balloon aortic dilation (BAD). We aimed to evaluate the longer term outcomes of SAV versus BAD at our institution. Methods: We retrospectively reviewed the outcomes of 2 months to 18 years old patients who underwent SAV or BAD at our institution between January 1990 and July 2018. Baseline and follow-up characteristics were assessed by echocardiography. Long-term survival, freedom from reintervention, freedom from aortic valve replacement (AVR), and aortic regurgitation were evaluated. Results: A total of 212 patients met inclusion criteria (SAV = 123; BAD = 89). Age, sex, aortic insufficiency (AI), and aortic valve gradient were similar between the groups. At 10 years, 27.9% (19/68) of SAV patients and 58.3% (28/48) of BAD patients had moderate or worse AI ( P = .001), and reintervention occurred in 39.2% (29/74) of SAV patients and 78.6% (44/56) of BAD patients ( P < .001). Kaplan-Meier analysis revealed overall survival was 96.8% (119/123) for SAV and 95.5% (85/89) for SAV ( P = .87). At 10 years, 35% (23/66) of SAV patients and 54% (23/43) of BAD patients underwent AVR ( P = .213). Conclusions: Surgical aortic valvuloplasty demonstrated greater gradient reduction, less postoperative and long-term AI, and a lower reintervention rate at 10 years than BAD. There was no difference in survival or AVR reintervention rate. Surgical aortic valvuloplasty is a durable and efficacious intervention and should continue to be considered a favorable choice for palliation of valvular AS.

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.

Relation of left ventricular mass, volume and mass/volume ratio in children with aortic stenosis and/or insufficiency

1995 ◽  
Vol 5 (2) ◽  
pp. 105-109
Author(s):  
Jennifer S. Li ◽  
A. Rebecca Snider ◽  
Hani Zreik ◽  
Brenda E. Armstrong ◽  
James W. NeSmith ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Aortic Stenosis ◽  
Left Ventricular Mass ◽  
Ventricular Hypertrophy ◽  
Volume Ratio ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Mass Volume ◽  
Electrocardiographic Abnormalities ◽  
Peak Gradient

AbstractTo determine if symptoms and electrocardiographic abnormalities relate to left ventricular mass, volume, and mass/volume ratio in children with aortic stenosis and/or insufficiency, we examined 42 patients (aged 11±6 years) with cross-sectional and Doppler echocardiography. Clinical symptoms included exertional chest pain, shortness of breath, exercise intolerance, congestive heart failure and syncope. Electrocardiographic abnormalities were defined as the presence of both left ventricular hypertrophy and ST-T wave changes. Left ventricular volumes and mass were measured from echocardiograms using paired orthogonal apical views and biplane Simpson's and truncated ellipsoid models, respectively. The peak and mean pressure gradients across the aortic valve, the aortic valvar area, and the degree of aortic insufficiency were determined using echo/Doppler techniques. Eighteen patients (ages 10±7 years) had pure aortic stenosis (peak gradient 52±29 mm Hg, mean gradient 28±18 mm Hg, and valve area 0.86±.46 cm2/m2). Of these 18, seven had symptoms and seven had an abnormal electrocardiogram. Twenty-four patients (aged 12±6 years) had aortic stenosis and aortic insufficiency (peak gradient 36±18 mm Hg, mean gradient 19±9 mm Hg, 18 with 1−2+ aortic insufficiency and six with 3−4+ aortic insufficiency). Of these 24, 10 had symptoms and 10 had an abnormal electrocardiogram. When symptomatic and asymptomatic patients were compared using an unpaired Student's t-test, symptomatic patients with pure aortic stenosis and combined aortic stenosis and insufficiency had left ventricular hypertrophy and inappropriately increased mass/volume ratios. However, due to differences in left ventricular volume, symptoms and electrocardiographic abnormalities occurred at a higher mass/ volume ratio in pure aortic stenosis (2.7±0.6) than in combined aortic stenosis and insufficiency (1.7±0.3).

scholarly journals Are Outcomes of Surgical Versus Transcatheter Balloon Valvotomy Equivalent in Neonatal Critical Aortic Stenosis?

Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
Brian W. McCrindle ◽  
Eugene H. Blackstone ◽  
William G. Williams ◽  
Rekwan Sittiwangkul ◽  
Thomas L. Spray ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Aortic Valve Stenosis ◽  
Balloon Dilation ◽  
Left Ventricular ◽  
Critical Aortic Stenosis ◽  
Significant Difference ◽  
Initial Procedure ◽  
Second Procedure

Background For neonates with critical aortic valve stenosis who are selected for biventricular repair, valvotomy can be achieved surgically (SAV) or by transcatheter balloon dilation (BAV). Methods and Results Data regarding 110 neonates with critical aortic valve stenosis were evaluated in a study by the Congenital Heart Surgeons Society from 1994 to 1999. Reduced left ventricular function was present in 46% of neonates. The initial procedure was SAV in 28 patients and BAV in 82 patients. Mean percent reduction in systolic gradient was significantly greater with BAV (65±17%) than SAV (41±32%; P <0.001). Higher residual median gradients were present in the SAV versus BAV group (36 mm Hg [range, 10 to 85 mm Hg] versus 20 mm Hg [0 to 85 mm Hg], P <0.001). Important aortic regurgitation was more often present after BAV (18%) than SAV (3%; P =0.07). Time-related survival after valvotomy was 82% at 1 month and 72% at 5 years, with no significant difference for SAV versus BAV, even after adjustment for differences in patient and disease characteristics. Independent risk factors for mortality were mechanical ventilation before valvotomy, smaller aortic valve annulus ( z score), smaller aortic diameter at the sinotubular junction ( z score), and a smaller subaortic region. A second procedure was performed in 46 survivors. Estimates for freedom from reintervention were 91% at 1 month and 48% at 5 years after the initial valvotomy and did not differ significantly between groups. Conclusions SAV and BAV for neonatal critical aortic stenosis have similar outcomes. There is a greater likelihood of important aortic regurgitation with BAV and of residual stenosis with SAV.

A Novel Approach: Trans-ascending Aorta Balloon Aortic Valvuloplasty via Sternotomy for Treating Severe Valvular Aortic Stenosis in a Low-Weight Infant

2014 ◽  
Vol 17 (1) ◽  
pp. 25 ◽  
Author(s):  
Lei Gao ◽  
Qin Wu ◽  
Xinhua Xu ◽  
Tianli Zhao ◽  
Wancun Jin ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Transesophageal Echocardiography ◽  
Severe Aortic Stenosis ◽  
Ascending Aorta ◽  
Balloon Aortic Valvuloplasty ◽  
Congenital Aortic Stenosis ◽  
Novel Approach ◽  
Low Weight ◽  
Aortic Valvuloplasty ◽  
Peak Gradient

<p><b>Background:</b> Severe congenital aortic stenosis in infants is a life-threatening congenital heart anomaly that is typically treated using percutaneous balloon aortic valvuloplasty.</p><p><b>Methods:</b> The usual route is the femoral artery under radiographic guidance. However, this procedure may be limited by the small size of the femoral artery in low-weight infants. An infant weighing only 7 kg with severe aortic stenosis (peak gradient was 103 mmHg) was successfully treated with a novel approach, that is trans-ascending aorta balloon aortic valvuloplasty guided by transesophageal echocardiography.</p><p><b>Results:</b> The patient tolerated the procedure well, and no major complications developed. After the intervention, transesophageal echocardiography indicated a significant reduction of the aortic valvular peak gradient from 103 mmHg to 22 mmHg, no aortic regurgitation was found. Eighteen months after the intervention, echocardiography revealed that the aortic valvular peak gradient had increased to 38 mmHg and that still no aortic regurgitation had occurred.</p><p><b>Conclusions:</b> In our limited experience, trans-ascending aorta balloon aortic valvuloplasty for severe aortic stenosis under transesophageal echocardiography guidance effectively reduces the aortic peak gradient. As this is a new procedure, long-term follow up and management will need to be established. It may be an alternative technique to treat congenital aortic stenosis in low-weight patients.</p>

Comparison of Aortic Gradient and Ventricular Mass after Valve Replacement for Aortic Stenosis with Rapid Deployment, Sutureless, and Conventional Bioprostheses

Cardiology ◽  
2021 ◽  
pp. 1-11
Author(s):  
Rubén Taboada-Martín ◽  
José María Arribas-Leal ◽  
María Asunción Esteve-Pastor ◽  
José Abellán Alemán ◽  
Francisco Marín ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Ventricular Mass ◽  
Risk Of Mortality ◽  
Echocardiographic Parameters ◽  
Rapid Deployment ◽  
The Impact ◽  
Peak Gradient

<b><i>Background:</i></b> The use of rapid deployment and sutureless aortic prostheses is increasing. Previous reports have shown promising results on haemodynamic performance and mortality rates. However, the impact of these bioprostheses on left ventricular mass (LVM) regression remains unknown. We decided to study the changes in remodelling and LVM regression in isolated severe aortic stenosis treated with conventional or Perceval® or Intuity® valves. <b><i>Method and Results:</i></b> From January 2011 to January 2016, 324 bioprostheses were implanted in our centre. The collected characteristics were divided into 3 groups: conventional valves, Perceval®, and Intuity®, and they were analysed after 12 months. There were 183 conventional valves (56%), 72 Perceval® (22%), and 69 Intuity® (21.2%). The statistical analysis showed significant differences in transprosthetic postoperative peak gradient (23 [18–29] mm Hg vs. 21 [16–29] mm Hg and 18 [14–24] mm Hg, <i>p</i> &#x3c; 0.001), ventricular mass electrical criteria regression (Sokolow and Cornell products), and 1-year survival (90 vs. 93% and 97%, log rank <i>p</i> value = 0.04) in conventional, Perceval®, and Intuity® groups. <b><i>Conclusions:</i></b> We observed differences in haemodynamic, electrocardiographic, and echocardiographic parameters related to the different types of prosthesis. Patients with the Intuity® prosthesis had the highest reduction in peak aortic gradient and the higher ventricular mass regression. Besides, patients with the Intuity® prosthesis had less risk of mortality during follow-up than the other two groups. Further studies are needed to confirm these findings.

Abstract 121: Improvement in Functional Mitral Regurgitation After Isolated Aortic Valve Replacement for Aortic Insufficiency

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Griffin Boll ◽  
Frederick Y Chen
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Reverse Remodeling ◽  
Lv Remodeling

Objective: Aortic insufficiency (AI) can lead to left ventricular (LV) remodeling characterized by dilation and increased LV mass. This remodeling can cause altered mitral valve coaptation and functional mitral regurgitation (FMR). While there is growing evidence that aortic valve replacement (AVR) for aortic stenosis promotes sufficient ventricular reverse remodeling that FMR improves or resolves, this effect is not well characterized for patients with AI. Methods: All cases of AVR for AI that were performed at a single center between January 2003 and December 2015 were reviewed. Cases with any concomitant procedures, any degree of aortic stenosis, any evidence of ischemic etiology, absence of mitral regurgitation, or significant primary mitral pathology were excluded from analysis. The primary outcome was change in FMR after isolated AVR. Secondary outcomes included change in LV ejection fraction (EF), left atrial (LA) dimension, and change in end-diastolic and –systolic LV dimensions. Two-tailed paired t-test was used to evaluate for difference between the two time points. Results: Over the course of 13.4 years, 31 cases of isolated aortic valve replacement for pure aortic insufficiency with concurrent functional mitral regurgitation were identified. 54.8% (17/31) of cases had some evidence of bacteremia or aortic vegetations at time of surgery, with 41.9% (13/31) of cases completed urgently. Postoperatively, FMR was improved in 74.2% (23/31) of the patients, and decreased by a mean 1.0 ± 0.8 grades (1.6 ± 0.8 vs 0.6 ± 0.7, p < 0.001). There was no significant change in LV EF (50.5 ± 13.4 vs. 50.2 ± 12.9, p = 0.892) or LA dimension (42.5 ± 7.2 vs 40.7 ± 5.9, p = 0.341), but there were significant reductions in the dimension of the LV at end-diastole (56.7 ± 7.1 vs 47.7 ± 8.5, p < 0.001) and end-systole (38.5 ± 9.7 vs 34.0 ± 8.3, p = 0.011). Conclusions: Significant reduction in ventricular size and subsequent improvement in functional mitral regurgitation is expected after isolated aortic valve replacement for pure aortic insufficiency.

P624The prognostic value of myocardial deformation in patients with congenital aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R W J Van Grootel ◽  
A T Van Den Hoven ◽  
D Bowen ◽  
T Ris ◽  
J W Roos-Hesselink ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Stenosis ◽  
Prognostic Value ◽  
Nyha Class ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Congenital Aortic Stenosis

Abstract Background Congenital aortic stenosis (AoS) is associated with significant mortality and morbidity but predictors for clinical outcome are scarce. Strain analysis provides a robust and reproducible method for early detection of left ventricular (LV) dysfunction, which might be of prognostic value. Therefore we aimed to assess the prognostic value of LV global longitudinal strain (GLS) and global longitudinal early diastolic strain rate (GLSre) with regard to cardiovascular events. Methods This prospective study, included clinically stable patients with congenital AoS between 2011–2013. LV GLS and GLSre was performed in the apical 4, 3 and 2-chamber views using Tomtec software. The endpoint was a composite of death, heart failure, hospitalization, arrhythmia, thrombo-embolic events and re-intervention. Results In total 138 patients were included (33 [26–43] years, 86 (62%) male), NYHA class I: 134 (97%). Mean LV GLS was −15.3±3.2%, GLSre 0.66±0.18 s–1. Both correlated with NT-proBNP, LV volumes and ejection fraction (strongest LV GLS with LV EF: r −0.539, p<0.001, strongest LV GLSre with age: r −0.376 p<0.001). During median follow-up of 5.9 [5.5–6.2] years, the endpoint occurred in 53 (38%) patients: 4 patients died, 9 developed heart failure, 22 arrhythmias, 8 thrombo-embolic events and 35 re-interventions. Both LV GLS (standardized HR (sHR 0.62 (95% CI 0.47–0.81) and GLSre (sHR 0.62 (95% CI 0.47–0.83) were associated with the endpoint. Additional multivariable analysis showed that both GLS and GLSre were associated independent of left atrial volume, NT-proBNP and prior re-interventions. Figure 1 Conclusion Left ventricular GLS and GLSre are reduced in adult patients with congenital AoS. Both markers are associated with adverse cardiac events and have clear clinical relevance Acknowledgement/Funding Erasmus Thorax Foundation

The carotid arterial approach for balloon dilation of critical aortic stenosis in neonates—immediate results and follow-up

1995 ◽  
Vol 5 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Sandra Giusti ◽  
Adele Borghi ◽  
Sofia Redaelli ◽  
Philipp Bonhoeffer ◽  
Isabella Spadoni ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Balloon Dilation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Critical Aortic Stenosis ◽  
The Right

SummaryBalloon dilation of the aortic valve was performed in 20 consecutive neonates with critical aortic stenosis using an approach achieved by cutting down on the right carotid artery. The age of the patients ranged from one to 25 days (mean seven days) and their weight from 2.1 to 4.0 kg (mean 3.16 kg). All patients were evaluated before cardiac catheterization with cross-sectional and Doppler echocardiography so as to keep the catheterization procedure as short as possible. Balloon dilation was accomplished in all patients. The only complication was an apical perforation by the guide wire in two cases. The ensuing pericardial effusion was immediately drained with pericardiocentesis and the subsequent course of the procedure was uneventful. Immediate results showed dramatic improvement in cardiovascular conditions. The transvalvar pressure gradient fell from 80±40 to 27±20 mm Hg (p<0.001). Left ventricular ejection fraction evaluated by echocardiography increased from 30±21% before dilation to 54±18% 24-48 hours after the procedure (p<0.001). In all patients, the procedure was free from vascular complications. Aortic regurgitation was documented after the procedure in 11 patients, being severe in one, moderate in five and trivial in five. Seven patients died, although in only one was the death related directly to the procedure itself. Six patients died because of associated lesions despite an immediate satisfactory result of the balloon valvoplasty. The 13 surviving patients are doing well, and are receiving no medications. During a mean follow-up of 25 months (range 2-54 months), four patients have developed restenosis. One underwent surgical valvotomy at one year of age. The second was successfully redilated through the same approach at two months of age. The other two have a significant gradient, as assessed by Doppler measurements (60 and 70 mm Hg), with normal systolic ventricular function. Two patients have moderate aortic regurgitation. Balloon dilation achieved through cutdown on the right carotid artery is a safe and effective alternative to surgery in neonates with isolated aortic stenosis. The unfavorable results are mainly due to associated anomalies.

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