Congenital: Aortic Valve
Aortic stenosis of the neonate: A single-center experience

https://doi.org/10.1016/j.jtcvs.2018.08.089Get rights and content
Under an Elsevier user license
open archive

Abstract

Objectives

Because data for neonates are limited, optimal management of critical aortic stenosis remains controversial (balloon valvotomy [BV] or open valvoplasty [OV]). In a center with balanced experience in both methods, we hypothesized that OV can provide a better individualized approach than blunt BV and better serve long-term outcomes.

Methods

A retrospective review of data and follow-up (survival, freedom from operation/replacement) of all neonates, suitable for biventricular repair, undergoing aortic valve procedure (1989-2015), was performed.

Results

One hundred three patients were concomitantly treated (BV [n = 51], OV [n = 52). Median age was 8 days, median aortic annulus Z-score was −1.3 for BV (range, −3.9 to 2.0) and OV (−3.9 to 3.2) groups. Operative mortality after BV or OV was 8% (n = 4) and 4% (n = 2), respectively. With a 13-year median follow-up, 10-year freedom from operation was 36% and 66% after BV or OV, respectively. Valve replacement was ultimately required in 32 patients (n = 20 [39%] in the BV group; n = 12 [23%] in the OV group) within a 5.9-year median time. After OV, tricuspid arrangement of the repaired aortic valve provided a 10-year freedom from operation and replacement of 87% and 95%, respectively. In multivariate analysis, associated left heart malformations, BV, nontricuspid geometry, and inadequate post procedural result were predictive of operation and replacement.

Conclusions

In neonates with critical aortic stenosis, both methods (BV and OV) offer excellent survival benefit. OV significantly minimizes the need for operation, whereas BV did not postpone age of replacement. Clearly superior results are achieved with OV when a post repair tricuspid arrangement is obtained.

Key Words

critical aortic stenosis
aortic valve repair
neonate
CHD
valve (lesions, repair, replacement)
cardiac catheterization/intervention
outcomes (mortality, morbidity, survival)

Abbreviations and Acronyms

AS
aortic stenosis
BV
balloon valvotomy
CI
confidence interval
LCOS
low cardiac output
LV
left ventricle
OV
open valvoplasty

Cited by (0)

Mathieu Vergnat receives grant support from the French Federation of Cardiology.