Current-Era Outcomes of Balloon Aortic Valvotomy in Neonates and Infants

Anders H Christensen; Rajiv R Chaturvedi; Connor P Callahan; Kyong-Jin Lee; Andrea Wan; David J Barron; Osami Honjo; Lee N Benson

doi:10.1016/j.jacadv.2022.100004

Current-Era Outcomes of Balloon Aortic Valvotomy in Neonates and Infants

JACC Adv. 2022 Mar 16;1(1):100004. doi: 10.1016/j.jacadv.2022.100004. eCollection 2022 Mar.

Authors

Anders H Christensen^{1

2}, Rajiv R Chaturvedi¹, Connor P Callahan³, Kyong-Jin Lee⁴, Andrea Wan¹, David J Barron³, Osami Honjo³, Lee N Benson¹

Affiliations

¹ Department of Pediatrics, The Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children, Temerty Faculty of Medicine, Toronto, Ontario, Canada.
² Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
³ Division of Cardiovascular Surgery, The Hospital for Sick Children, Temerty Faculty of Medicine, Toronto, Ontario, Canada.
⁴ Stanford University School of Medicine, Palo Alto, California, USA.

Abstract

Background: The optimal initial treatment pathway for aortic valve stenosis remains debated.

Objectives: The objective of this study was to review current outcomes of balloon aortic valvotomy (BAV) in neonates and infants.

Methods: Neonates and infants with a biventricular circulation treated with BAV between 2004 and 2019 were reviewed.

Results: One hundred thirty-nine infants (48% neonates) with median (Q1, Q3) age of 33(7, 84) days and weight 4.0 (3.4, 5.1) kg were followed up for 7.1 (3.3, 11.0) years. BAV reduced peak-to-peak gradient from mean (SD) 52 (16) mmHg to 18 (12) mmHg; P < 0.001. Aortic regurgitation (AI) increased with time after BAV. Three children died during follow-up. Fifty-one reinterventions (26 BAV, 19 aortic valve replacements [AVRs], and 6 surgical valvotomies) were performed on 40 children. Freedom from AVR (95% CI) was 96% (93%-99%) at 1, 91% (86%-96%) at 5, and 86% (79%-93%) at 10 years. The predictors of AVR were a unicommissural valve (hazard ratio [HR] [95% CI]: 3.7 [1.4-9.6]; P = 0.007) and moderate to severe AI after index BAV (HR [95% CI]: 3.3 [1.1-9.7]; P = 0.029). Freedom from reintervention was 84% (78%-90%) at 1, 76% (69%-83%) at 5, and 69% (60-78%) at 10 years. Main predictors of reintervention were age below 1 month (HR [95% CI]: 2.1 [1.1-4.1]; P = 0.032) and postdilation peak-to-peak gradient (per 10-mmHg increase; HR [95% CI]: 1.36 [1.02-1.79]; P = 0.032).

Conclusions: BAV is a safe and effective treatment for aortic valve stenosis in neonates and infants. Outcomes are competitive with contemporary published data on aortic valve repair in relation to mortality, gradient relief, long-term AVR, and reintervention rates. In the absence of significant AI, surgery can be reserved for those with gradients resistant to valve dilation.

Keywords: aortic valve replacement; aortic valve stenosis; balloon aortic valvotomy; congenital heart disease; reintervention; surgical aortic valvotomy.