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Balloon aortic valvotomy through a carotid cutdown in infants with severe aortic stenosis: results of the multi-centric registry

Published online by Cambridge University Press:  19 August 2008

Blair V. Robinson ,
Grazyna Brzezinska-Rajszys ,
Howard S. Weber ,
Joanna Ksiazyk ,
F. Jay Fricker ,
Donald R. Fischer  and
José A. Ettedgui
Blair V. Robinson*
Affiliation:
University of North Carolina, Chapel Hill, NC
Grazyna Brzezinska-Rajszys
Affiliation:
Children's Memorial Health Institute, Warsaw, Poland
Howard S. Weber
Affiliation:
Penn State University Children's Hospital, Hershey, PA
Joanna Ksiazyk
Affiliation:
University of North Carolina, Chapel Hill, NC
F. Jay Fricker
Affiliation:
University of Florida, Gainesville, FL
Donald R. Fischer
Affiliation:
Children's Hospital of Pittsburgh, Pittsburgh, PA.
José A. Ettedgui
Affiliation:
Children's Hospital of Pittsburgh, Pittsburgh, PA.
*
Blair Robinson, MD, Pediatric Cardiology Department, 311 Burnett-Womack Bldg. CB# 7220, Chapel Hill, NC 27599–7220. Tel: (919) 966–4601; Fax: (919) 966–6894; E-mail: brobins@med.unc.edu
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Abstract

Objectives

The purpose of this study was to evaluate the short and intermediate term results of infants who have undergone balloon aortic valvotomy from the carotid arterial approach, and to identify risk factors in those infants who had a poor outcome.

Methods

Between 1988 and 1999, balloon aortic valvotomy was attempted at four centres in 95 infants with severe aortic stenosis. Echocardiographic and hemodynamic data, and outcome, were analysed retrospectively.

Results

Valvotomy was accomplished in 92 of the 95 infants, with a median age of 5 days, a range from 0 to 191 days, and weighing 3.4 kg, with a range from 1.0 to 6.5 kg. Major procedural complications occurred in 10 infants. Post-procedural aortic regurgitation was severe in 5 patients. There were 13 early deaths, and 4 late deaths. The period of mean follow-up has been 2.1 years, with a range from 0 to 9.3 years. The actuarial survival at 3 years was 76 ± 6%. Further interventions were needed in 19 patients, giving a 3-year freedom from reintervention of 67 ± 6%. The 51 infants who were duct-dependent were further analyzed, and found to have a higher mortality (38%) compared to those infants not dependent on the arterial duct (5%). Risk factors for a poor outcome in the duct-dependent infants were mitral stenosis (p<0.005), a left ventricle which did not form the cardiac apex (p<0.005), and an aortic valve with a diameter of less than 6 mm (p<0.05).

Conclusions

This multi-centric registry shows good results in the intermediate term for treating infants with severe aortic valvar stenosis with balloon valvotomy through a carotid arterial cutdown. Infants dependent on prostaglandin had a worse outcome, especially if they had any of the identified risk factors.

Keywords

Balloonvalvoplastystenosiscongenital cardiac malformations
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 3 , May 2000 , pp. 225 - 232
Copyright
Copyright © Cambridge University Press 2000

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