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AORTIC VALVE REINTERVENTION AFTER BALLOON AORTIC VALVULOPLASTY FOR CONGENITAL AORTIC STENOSIS: INTERMEDIATE AND LATE FOLLOW-UP
A45.E436 JACC March 9, 2010 Volume 55, issue 10A
CONGENITAL CARDIOLOGY SOLUTIONS (PEDIATRIC CARDIOLOGY AND ADULT CONGENITAL HEART DISEASE) AORTIC VALVE REINTERVENTION AFTER BALLOON AORTIC VALVULOPLASTY FOR CONGENITAL AORTIC STENOSIS: INTERMEDIATE AND LATE FOLLOW-UP ACC Poster Contributions Georgia World Congress Center, Hall B5 Tuesday, March 16, 2010, 9:30 a.m.-10:30 a.m.
Session Title: Outcomes in Pediatric Cardiology Abstract Category: Pediatric Cardiology Presentation Number: 1280-397 Authors: David W. Brown, Amy E. Dipilato, Erin C. Chong, James E. Lock, Doff B. McElhinney, Children’s Hospital, Boston, MA Background: Transcatheter balloon aortic valvuloplasty (BAVP) is the preferred treatment for congenital aortic stenosis (AS). Aortic valve function and reintervention late after this procedure are not well characterized. Methods: Retrospective review of 563 patients who underwent BAVP for congenital AS from 1985-2008. Results: After exclusion of those converted to a univentricular circulation and/or died within 30 days, 509 patients comprised the study cohort. Median follow-up was 9.3 years (0.1-23.6 years); cumulative follow-up was 5003 patient-years. Median age was 2.4 years (1 day-40.5 years) and most patients (73%) had isolated native AS. Peak AS gradients decreased significantly after dilation (median decrease 35 mmHg). Acute postdilation aortic regurgitation (AR) was moderate or greater in 70 (14%), and more common in older patients (p<0.001). During follow-up, 225 (44%) underwent any aortic valve reintervention: repeat BAVP in 115, aortic valve repair in 65, and aortic valve replacement in 116. Survival free from any surgical aortic valve reintervention (repair or replacement) was 82±2% at 5 years, 69±3% at 10 years, and 46±4% at 20 years. In multivariate analyses, lower post-dilation AS gradient, lower grade of post-dilation AR, and absence of multiple left heart obstructive lesions were associated with longer freedom from surgical aortic valve reintervention, but age, era, and pre-dilation AS severity were not. Conclusions: While transcatheter BAVP is effective for relief of congenital AS, there are steady long-term hazards for surgical aortic valve reintervention and replacement that are independent of age at initial intervention or AS severity.
CONGENITAL CARDIOLOGY SOLUTIONS (PEDIATRIC CARDIOLOGY AND ADULT CONGENITAL HEART DISEASE) AORTIC VALVE REINTERVENTION AFTER BALLOON AORTIC VALVULOPLASTY FOR CONGENITAL AORTIC STENOSIS: INTERMEDIATE AND LATE FOLLOW-UP ACC Poster Contributions Georgia World Congress Center, Hall B5 Tuesday, March 16, 2010, 9:30 a.m.-10:30 a.m.
Session Title: Outcomes in Pediatric Cardiology Abstract Category: Pediatric Cardiology Presentation Number: 1280-397 Authors: David W. Brown, Amy E. Dipilato, Erin C. Chong, James E. Lock, Doff B. McElhinney, Children’s Hospital, Boston, MA Background: Transcatheter balloon aortic valvuloplasty (BAVP) is the preferred treatment for congenital aortic stenosis (AS). Aortic valve function and reintervention late after this procedure are not well characterized. Methods: Retrospective review of 563 patients who underwent BAVP for congenital AS from 1985-2008. Results: After exclusion of those converted to a univentricular circulation and/or died within 30 days, 509 patients comprised the study cohort. Median follow-up was 9.3 years (0.1-23.6 years); cumulative follow-up was 5003 patient-years. Median age was 2.4 years (1 day-40.5 years) and most patients (73%) had isolated native AS. Peak AS gradients decreased significantly after dilation (median decrease 35 mmHg). Acute postdilation aortic regurgitation (AR) was moderate or greater in 70 (14%), and more common in older patients (p<0.001). During follow-up, 225 (44%) underwent any aortic valve reintervention: repeat BAVP in 115, aortic valve repair in 65, and aortic valve replacement in 116. Survival free from any surgical aortic valve reintervention (repair or replacement) was 82±2% at 5 years, 69±3% at 10 years, and 46±4% at 20 years. In multivariate analyses, lower post-dilation AS gradient, lower grade of post-dilation AR, and absence of multiple left heart obstructive lesions were associated with longer freedom from surgical aortic valve reintervention, but age, era, and pre-dilation AS severity were not. Conclusions: While transcatheter BAVP is effective for relief of congenital AS, there are steady long-term hazards for surgical aortic valve reintervention and replacement that are independent of age at initial intervention or AS severity.