| Aortic valve reinterventions after balloon aortic valvuloplasty for congenital aortic stenosis intermediate and late follow-up. | |
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MedLine Citation:
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PMID: 21070926 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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David W Brown; Amy E Dipilato; Erin C Chong; James E Lock; Doff B McElhinney |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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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:
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Created Date: 2010-11-12 Completed Date: 2011-01-11 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1740-9 Citation Subset: AIM; IM |
Copyright Information:
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2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Cardiology, Children’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. david.brown@cardio.chboston.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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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