Long-term outcomes and re-interventions following balloon aortic valvuloplasty in pediatric patients with congenital aortic stenosis: A single-center study
| Autor: | Patrick M, Sullivan, Agustin E, Rubio, Troy A, Johnston, Thomas K, Jones |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Balloon Valvuloplasty
Male Washington Time Factors Adolescent Aortic Valve Insufficiency Kaplan-Meier Estimate Disease-Free Survival Young Adult Risk Factors Humans Child Proportional Hazards Models Retrospective Studies Chi-Square Distribution Hemodynamics Infant Newborn Infant Aortic Valve Stenosis Treatment Outcome Aortic Valve Child Preschool Multivariate Analysis Retreatment Heart Transplantation Female |
| Zdroj: | Catheterization and cardiovascular interventions : official journal of the Society for Cardiac AngiographyInterventions. 89(2) |
| ISSN: | 1522-726X |
| Popis: | 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.Few studies report long-term outcomes following BAV in infants and children.Kaplan-Meier estimates and proportional hazards regression were used in a retrospective study of 154 patients undergoing BAV from 1993 to 2013.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 gradient30 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]).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. |
| Databáze: | OpenAIRE |
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