Long-Term Outcomes and Re-Interventions Following Balloon Aortic Valvuloplasty in Pediatric Patients With Congenital Aortic Stenosis: A Single-Center Study

Objectives: To describe long-term risk of mortality, aortic insufficiency (AI), and re-intervention following balloon aortic valvuloplasty (BAV) in pediatric patients and to identify risk factors for re-intervention. Background: Few studies report long-term outcomes following BAV in infants and children. Methods: Kaplan-Meier estimates and proportional hazards regression were used in a retrospective study of 154 patients undergoing BAV from 1993 to 2013. Results: Seventy-six (49%) patients were neonates. Aortic stenosis (AS) gradients were reduced by 38619 mm Hg. Moderate or severe AI developed acutely in 19 (12%) patients. Estimates of fifteen-year transplant-free survival were 85% (95% CI: 73-92%) in neonates, 94% (95% CI: 80-96%) in infants, and 100% in older patients. Neonates had an elevated long-term risk of AI (P< 0.001) and left heart re-interventions (P=0.02). At 15 years, an estimated 32% (95% CI: 15-50%) of neonates and 44% (95% CI: 20-65%) of non-neonates remained free from re-intervention; an estimated 45% (95% CI: 26-63%) of neonates and 62% (95% CI: 40-77%) of non-neonates remained free of aortic valve replacement (AVR). Neonatal age, additional left heart lesions, higher pre-and post-dilation gradients, and acute AI were associated with LVOT re-interventions. Post-dilation gradient >= 30 mm Hg and acute AI were associated with AVR. Patients with moderate or severe acute AI but a residual AS gradient < 30 mm Hg had a greater risk of AVR compared to patients with a residual AS gradient >= 30 mm Hg but mild or less AI (HR: 2.98 [95% CI: 1.01-8.77]). Conclusions: While post-BAV survival is excellent, long-term risks of AI and re-intervention are significant. Acute AI is a more strongly associated with AVR than residual AS. (C) 2016 Wiley Periodicals, Inc.