Key result
Balloon dilation for congenital aortic stenosis achieves ~87% acute success, but half need reintervention by 8 years.
Why the study?
Factors that influence midterm success of balloon dilation for congenital aortic stenosis are unknown.
Cohort (n=148)
In children with congenital aortic stenosis, balloon dilation offers excellent 8-year survival (95%), though 50% require repeat intervention, with higher risk among those with significant post-procedural aortic regurgitation or residual gradients.
Supports balloon dilation as initial strategy in congenital aortic stenosis; leaves open durability, reintervention predictors, and need for randomized data.
OBJECTIVES: We evaluated patient and procedural characteristics that influence the midterm success of balloon dilation of congenital aortic stenosis. BACKGROUND: Balloon dilation is a new treatment for congenital aortic stenosis. Factors that influence midterm success are unknown. METHODS: We performed a retrospective review of 148 children >1 month old who underwent balloon dilation for aortic stenosis. RESULTS: Balloon dilation was successful in 87% of patients, with a procedural mortality rate of 0.7%. The average immediate peak to peak gradient reduction was 56.4 +/- 19.9% (mean +/- SD). Prior valvotomy was the only factor that significantly reduced the immediate gradient reduction after dilation (47.1 +/- 21.8% vs. 57.8 +/- 19.6%, p < 0.01). Survival after dilation was 95% at 8 years. Seventy-five percent of patients were free of repeat intervention 4 years after dilation, whereas 50% remained free of repeat intervention at 8 years. Asymmetrically thick valve leaflets (risk ratio [RR] 0.17, p < 0.01) and prior aortic valvotomy (RR 0.35, p = 0.02) decreased the risk of repeat intervention. Aortic regurgitation grade > or = 3 (RR 4.27, p = 0.04) and residual gradient after dilation (RR 1.63 for 10 mm Hg, p < 0.01) increased the risk. CONCLUSIONS: The 8-year survival rate after dilation was 95% with 50% of patients free of repeat intervention. Factors that increased the risk for repeat intervention included symmetrically thin or thick aortic valve leaflets, regurgitation grade > or = 3 after dilation and a high residual gradient after dilation. The incidence of repeat intervention after dilation was high owing to its palliative nature.
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Moore et al. (1996) conducted a cohort in congenital aortic stenosis (n=148). Balloon dilation was evaluated on procedural success. Balloon dilation for congenital aortic stenosis achieved an 87% procedural success rate and 95% 8-year survival, though 50% of patients required repeat intervention by 8 years.
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