Outcomes after balloon dilation of congenital aortic stenosis in children and adolescents.
OBJECTIVE
To determine the long-term outcomes and risk factors for, reintervention after balloon dilation of congenital aortic stenosis in children aged 6 months or older.


BACKGROUND
Although balloon dilation of congenital aortic stenosis has become a primary therapeutic strategy, few data are available regarding long-term outcomes.


METHODS
We carried out a retrospective review of 87 children who had undergone balloon dilation of the aortic valve at median age of 6.9 years.


RESULTS
The procedure was completed in 98% of the children, with an average reduction in the gradient across the valve of 64 +/- 28%, and without mortality. Of the children, 76 had been followed for a mean of 6.3 +/- 4.2 years. Reintervention on the aortic valve was required in 32 children, with 12 undergoing reintervention within 6 months, with 1 death. Another patient had died over the period of follow-up due to a non-cardiac event. Estimated freedom from reintervention was 86% at 1 year, 67% at 5 years, and 46% at 12 years. Parametric modeling of the hazard function showed a brief early phase of increased risk, superimposed on an ongoing constant risk. The only incremental risk factor for the early phase was a residual gradient immediately subsequent to the procedure greater than 30 mmHg. Incremental risk factors for the constant phase included the presence of symmetric valvar opening, and greater than moderate regurgitation immediately after dilation.


CONCLUSIONS
Long-term survival was excellent, albeit that the need for further reintervention was high due to the palliative nature of the procedure.
Pedra
Carlos A C
CA
Department of Pediatrics, Division of Cardiology, The Variety Club Catheterization Laboratories, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
Sidhu
Roger
R
McCrindle
Brian W
BW
Nykanen
David G
DG
Justo
Robert N
RN
Freedom
Robert M
RM
Benson
Lee N
LN
D000293:Adolescent; D001024:Aortic Valve Stenosis / Q000151:congenital* / Q000401:mortality / Q000628:therapy*; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome