Long-term results of percutaneous balloon valvuloplasty of congenital aortic stenosis in adolescents and young adults

Balloon aortic valvuloplasty (BAV) is a well accepted modality of treatment in congenital aortic stenosis in all age groups. Although in infants and children it is the modality of choice, in adolescents and young adults, it is of debatable efficacy. AIM: To evaluate long-term results of aortic valvuloplasty particularly in adolescent and adults (>12 years) and compare the outcome in other age groups that are <1 year and between 1 are 11 years. SETTING: Tertiary referral center. PATIENTS: 165 consecutive patients treated at the median age of 9 years (1 day to 64 years). The follow-up was up to 14 years (median 3 years). The whole cohort was divided into 3 age-based subgroups: Group A (<1 year) n=45, Group B (1 year-11 years) n=52, and Group C (>12 years) n=68. The characteristics of each subgroup were mutually compared. INTERVENTION: Percutaneous balloon valvuloplasty with mean (SD) balloon to annulus ratio of 0.93. Main outcome measures were repeat BAV, significant aortic regurgitation (AR), and aortic valve replacement/repair. RESULTS: The incidence of significant AR from the whole cohort was 9.9% (8% moderate, 1.9% severe); n=16. Group A=significant AR 9.5% (7.1% moderate, 2.4% severe), Group B=significant AR 11.3% (9.4% moderate, 1.9% severe), and Group C=significant AR 9% (7.5% moderate, 1.5% severe); p value=0.99 (Group C vs Group A) and 0.92 (Group C vs Group B). Repeat BAV rate was 13.3% (n=22 out of 165 patients). Group A - n=5 (11.9%), Group B - n=10 (18.2%), and Group C - n=7 (10.3%). p Value=0.78 (C vs A) and 0.19 (C vs B). Surgery in follow-up was needed in n=4 (2.4%), none in Group A, 2 patients in Group B (3.6%), and 2 patients in group C (2.9%). Patients were followed up for a period of 14 years; Group A=up to 8 years, Group B=up to 13 years, and Group C=up to 14 years. Mean survival probability after the procedure was 8 years (Group A=6.5 years, Group B=8.1 years, and Group C=9.9 years), and p value=0.49 (A vs B), 0.23 (B vs C), and 0.4 (A vs C). CONCLUSION: There is no statistical difference in the long-term outcome in the adults and adolescents as compared to the children; thus BAV remains an obvious treatment of choice with good long-term outcome.