Balloon dilatation versus surgical valvotomy for congenital aortic stenosis: a propensity score matched study.

Autor:	Auld BC; Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Australia.; UQ School of Medicine, University of Queensland, St Lucia, Australia., Donald JS; Royal Children's Hospital, Melbourne, Australia.; University of Melbourne, Parkville, Australia.; Murdoch Children's Research Institute, Parkville, Australia., Lwin N; Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Australia.; UQ School of Medicine, University of Queensland, St Lucia, Australia., Betts K; School of Public Health, Curtin University, Bentley, Australia., Alphonso NO; Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Australia.; UQ School of Medicine, University of Queensland, St Lucia, Australia., Venugopal PS; Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Australia.; UQ School of Medicine, University of Queensland, St Lucia, Australia., Justo RN; Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Australia.; UQ School of Medicine, University of Queensland, St Lucia, Australia., Ward CJ; Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Australia.; UQ School of Medicine, University of Queensland, St Lucia, Australia., Konstantinov IE; Royal Children's Hospital, Melbourne, Australia.; University of Melbourne, Parkville, Australia.; Murdoch Children's Research Institute, Parkville, Australia., Karl TR; Johns Hopkins School of Medicine, Baltimore, USA., Anderson BW; Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Australia.; UQ School of Medicine, University of Queensland, St Lucia, Australia.
Jazyk:	angličtina
Zdroj:	Cardiology in the young [Cardiol Young] 2021 Dec; Vol. 31 (12), pp. 1984-1990. Date of Electronic Publication: 2021 Apr 16.
DOI:	10.1017/S1047951121001281
Abstrakt:	Background: Balloon valvuloplasty and surgical aortic valvotomy have been the treatment mainstays for congenital aortic stenosis in children. Choice of intervention often differs depending upon centre bias with limited relevant, comparative literature. Objectives: This study aims to provide an unbiased, contemporary matched comparison of these balloon and surgical approaches. Methods: Retrospective analysis of patients with congenital aortic valve stenosis who underwent balloon valvuloplasty (Queensland Children's Hospital, Brisbane) or surgical valvotomy (Royal Children's Hospital, Melbourne) between 2005 and 2016. Patients were excluded if pre-intervention assessment indicated ineligibility to either group. Propensity score matching was performed based on age, weight, and valve morphology. Results: Sixty-five balloon patients and seventy-seven surgical patients were included. Overall, the groups were well matched with 18 neonates/25 infants in the balloon group and 17 neonates/28 infants in the surgical group. Median age at balloon was 92 days (range 2 days - 18.8 years) compared to 167 days (range 0 days - 18.1 years) for surgery (rank-sum p = 0.08). Mean follow-up was 5.3 years. There was one late balloon death and two early surgical deaths due to left ventricular failure. There was no significant difference in freedom from reintervention at latest follow-up (69% in the balloon group and 70% in the surgical group, p = 1.0). Conclusions: Contemporary analysis of balloon aortic valvuloplasty and surgical aortic valvotomy shows no difference in overall reintervention rates in the medium term. Balloon valvuloplasty performs well across all age groups, achieving delay or avoidance of surgical intervention.
Databáze:	MEDLINE
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