title: Long-term outcomes and re-interventions following balloon aortic valvuloplasty in pediatric patients with congenital aortic stenosis: A single-center study.
abstract: OBJECTIVE
  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 38 ± 19 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. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Sullivan
authors.affiliation: Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Agustin E
authors.initials: AE
authors.lastname: Rubio
authors.affiliation: Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Troy A
authors.initials: TA
authors.lastname: Johnston
authors.affiliation: Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D001021:Aortic Valve / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000628:therapy; D001024:Aortic Valve Stenosis / Q000151:congenital / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014861:Washington; D055815:Young Adult
keywords: aortic valve disease; congenital heart disease; pediatric intervention; pediatrics; percutaneous intervention