title: Acute outcomes after introduction of a standardized clinical assessment and management plan (SCAMP) for balloon aortic valvuloplasty in congenital aortic stenosis.
abstract: BACKGROUND
  Standardization of care can reduce practice variation, optimize resource utilization, and improve clinical outcomes. We have created a standardized clinical assessment and management plan (SCAMP) for patients having balloon aortic valvuloplasty (BAV) for congenital aortic stenosis (AS). This study compares acute outcomes of BAV at our institution before and after introduction of this SCAMP.
  
  
  METHODS
  In this retrospective matched cohort study, each SCAMP patient was matched to four historical controls. Outcomes were categorized based on the combination of residual AS and aortic regurgitation (AR) as: (1) Optimal: gradient ≤ 35 mm Hg and trivial or no AR; (2) Adequate: gradient ≤ 35 mm Hg and mild AR; (3) Inadequate: gradient > 35 mm Hg and/or moderate or severe AR.
  
  
  RESULTS
  All 23 SCAMP patients achieved a residual AS gradient ≤ 35 mm Hg; the median residual AS gradient for the SCAMP group was lower (25 [10-35] mm Hg) than in matched controls (30 [0-65] mm Hg; P = 0.005). The two groups did not differ with regard to degree of AR grade after BAV. Compared with controls, SCAMP patients were more likely to have an optimal result and less likely to have an inadequate result (52% vs. 34% and 17% vs. 45%, respectively; P = 0.02) CONCLUSIONS: A SCAMP for BAV resulted in optimal acute results in half of the initial 23 patients enrolled, and outcomes in this group were better than those of matched historical controls. Whether these improved acute outcomes translate into better long-term outcomes for this patient population remains to be seen.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Mass, USA; Department of Pediatrics, Harvard Medical School, Boston, Mass, USA.
authors.forename: Diego
authors.initials: D
authors.lastname: Porras
authors.forename: David W
authors.initials: DW
authors.lastname: Brown
authors.forename: Rahul
authors.initials: R
authors.lastname: Rathod
authors.forename: Kevin
authors.initials: K
authors.lastname: Friedman
authors.forename: Kimberly
authors.initials: K
authors.lastname: Gauvreau
authors.forename: James E
authors.initials: JE
authors.lastname: Lock
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Esch
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergersen
authors.forename: Audrey C
authors.initials: AC
authors.lastname: Marshall
mesh_terms: D001021:Aortic Valve / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000151:congenital / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015397:Program Evaluation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic Stenosis; Balloon Aortic Valvuloplasty; Congenital Heart Disease