Outcomes following Balloon Aortic Valvuloplasty in Congenital Aortic Valve Stenosis: A Single Centre Experience over 30 Years

Background: The optimal treatment for congenital aortic valve stenosis has been of debate over the past decades. Balloon aortic valvuloplasty (BAV) has been the primary treatment strategy in many centers. We report our single-center experience with BAV over a period of more than 30 years.

Method: Review of all patients undergoing BAV between 1989 and 2020 as a primary procedure. Procedural data and echocardiographic parameters before and after intervention were collected on all patients. Survival, freedom from reintervention and freedom from aortic valve repair or replacement were evaluated.

Results: Overall, 186 BAVs were performed in 157 patients (114 males and 43 females), including 55 neonates with duct-dependent systemic blood flow in 31 cases. Median procedural age in neonates was 3 (IQR: 1–8) days and 1.8 (IQR: 0.3–10.1) years in the remainder. BAV resulted in reduction of the pressure gradient from 62 ± 21 mm Hg to 25 ± 13 mm Hg (p < 0.001). A residual gradient above 50 mm Hg was present after 9 procedures. New onset of mostly mild aortic regurgitation was noted on postprocedural echocardiography after 83 (44.6%) procedures. Cumulative survival for the entire cohort without catheter or surgical reintervention was 50% at 10 years. The worst outcome was noticed in patients treated during the neonatal period. Eleven patients with critical aortic stenosis died, seven after the primary procedure. Treatment strategy was converted to univentricular palliation in five cases. Survival without catheter or surgical reintervention was 50.4 and 42.3% at 1 and 5 years, respectively. There was no mortality beyond the neonatal period. Freedom from catheter or surgical reintervention was 79.8 and 58.7% at 5 and 10 years, respectively. Freedom from aortic valve reconstruction or replacement was 80.2 and 67.2% at 5 and 10 years, respectively. In terms of aortic valve morphology, there was no difference between tricuspid and bicuspid aortic valves. The presence of aortic valve regurgitation on postprocedural echocardiography was related to the need for later aortic valve surgery. Freedom from surgery at 10 years was 84.7% in patients without aortic regurgitation and 59.5% in those with any degree of aortic regurgitation.

Conclusion: Balloon aortic valvuloplasty is a safe and effective primary treatment for congenital aortic valve stenosis with the potential of postponing or even avoiding surgical intervention until adulthood. However, neonates with critical aortic valve stenosis remain a particularly high-risk group.

Publication History

Article published online:
12 February 2022