Document Detail


Aortic valve reinterventions after balloon aortic valvuloplasty for congenital aortic stenosis intermediate and late follow-up.
MedLine Citation:
PMID:  21070926     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: the aim of this study was to evaluate the long-term results of transcatheter balloon aortic valvuloplasty, the preferred treatment for congenital aortic stenosis (AS).
BACKGROUND: aortic valve function and reintervention late after this procedure are not well characterized.
METHODS: from 1985 to 2008, 563 patients underwent balloon dilation for congenital AS. After excluding those converted to univentricular circulation and/or died ≤ 30 days after the procedure, 509 patients constituted the study cohort.
RESULTS: The median follow-up period was 9.3 years (range 0.1 to 23.6 years); cumulative follow-up was 5,003 patient-years. The median age was 2.4 years (range 1 day to 40.5 years), and most patients (73%) had isolated native AS. Peak AS gradients decreased significantly after dilation (median decrease, 35 mm Hg), and acute post-dilation aortic regurgitation was moderate or greater in 70 patients (14%). Older patients more often had post-dilation aortic regurgitation (p < 0.001). During follow-up, 225 patients (44%) underwent aortic valve reintervention: repeat balloon dilation in 115 (23%), aortic valve repair in 65 (13%), and aortic valve replacement in 116 (23%). Survival free from any aortic valve reintervention was 89 ± 1% at 1 year, 72 ± 2% at 5 years, 54 ± 3% at 10 years, and 27 ± 3% at 20 years. Freedom from aortic valve replacement was 90 ± 2% at 5 years, 79 ± 3% at 10 years, and 53 ± 4% at 20 years. In multivariate analyses, lower post-dilation AS gradient and lower grade of post-dilation aortic regurgitation were associated with longer freedom from aortic valve replacement, but age, era, and pre-dilation AS severity were not.
CONCLUSIONS: although transcatheter aortic valvuloplasty 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.
Authors:
David W Brown; Amy E Dipilato; Erin C Chong; James E Lock; Doff B McElhinney
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  56     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-12     Completed Date:  2011-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1740-9     Citation Subset:  AIM; IM    
Copyright Information:
2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiology, Children’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. david.brown@cardio.chboston.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aortic Valve Insufficiency / etiology,  mortality,  surgery*
Aortic Valve Stenosis / congenital,  mortality,  therapy*
Balloon Dilation / methods*
Child
Child, Preschool
Follow-Up Studies
Heart Valve Prosthesis Implantation / methods*
Humans
Infant
Infant, Newborn
Massachusetts / epidemiology
Reoperation*
Retrospective Studies
Survival Rate / trends
Time Factors
Treatment Failure
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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