Long-term follow-up results of balloon valvuloplasty for congenital aortic stenosis: predictors of late outcome.
OBJECTIVE
Long-term follow-up of patients with aortic valve stenosis undergoing balloon valvuloplasty was evaluated with respect to survival, the need for repeat intervention and factors predicting late outcome.


RESULTS
Forty-five patients between 3.5 to 23 years old (mean 11.7 +/- 4.5) were followed for 62 +/- 30 months (range 11-122). The transvalvar aortic gradient decreased from 84 +/- 20 to 36 +/- 10 mmHg (p < 0.001) and remained significantly lower (50 +/- 26 mmHg; p < 0.001) at follow-up. At that time, 10 patients (including 4 with significant valve incompetence) had gradients >/= 60 mmHg. The procedure resulted in significant valve incompetence (grade >/= 3) in 8 patients (17.8%). There was a progression of incompetence and 13 patients (28.9%) had significant regurgitation at follow-up. All survived. Fifteen patients (33.3%) required re-intervention 51 +/- 24 months after valvuloplasty. The indications were: aortic stenosis in 5 patients; regurgitation in 6 patients; and stenosis with regurgitation in 4 patients. Actuarial freedom from re-intervention at 2, 4, 6 and 8 years was 96%, 88%, 61% and 56% of patients, respectively. The residual post-valvuloplasty gradient was the only predictor of re-intervention for valve stenosis (odds ratio = 3.2 for every 10 mmHg gradient increase; p = 0.017). A residual post-valvuloplasty gradient >/= 40 mmHg increased the relative risk of re-intervention sixfold. The immediate post-valvuloplasty aortic regurgitation grade was the only risk factor of re-intervention for regurgitation (odds ratio = 34 for every incompetence degree increase; p = 0.0019). Incompetence grade >/= 2 increased the risk of re-intervention tenfold.


CONCLUSIONS
Valvuloplasty carries the risk of development of valve incompetence, which progresses with time. Some patients develop restenosis. The </= 10 year survival after the procedure is excellent, and 56% of patients are free of re-intervention at 8 years. The immediate post-valvuloplasty incompetence grade and transvalvar gradient are the predictors of late re-intervention.
Demkow
M
M
Department of General Cardiology, National Institute of Cardiology, Warsaw, Poland.
Ruzyllo
W
W
Ksiezycka
E
E
Szaroszyk
W
W
Lubiszewska
B
B
Przyluski
J
J
Rozanski
J
J
Wilczynski
J
J
Hoffman
P
P
Rydlewska-Sadowska
W
W
D000293:Adolescent; D000328:Adult; D001024:Aortic Valve Stenosis / Q000151:congenital* / Q000401:mortality / Q000628:therapy*; D002404:Catheterization / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000628:therapy; D006801:Humans; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome