Long-term outcomes and re-interventions following balloon aortic valvuloplasty in pediatric patients with congenital aortic stenosis: A single-center study.
Catheter Cardiovasc Interv
; 89(2): 288-296, 2017 Feb 01.
Article
em En
| MEDLINE
| ID: mdl-27650723
ABSTRACT
OBJECTIVES:
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.BACKGROUND:
Few studies report long-term outcomes following BAV in infants and children.METHODS:
Kaplan-Meier estimates and proportional hazards regression were used in a retrospective study of 154 patients undergoing BAV from 1993 to 2013.RESULTS:
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 gradient <30 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]).CONCLUSIONS:
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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Valva Aórtica
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Estenose da Valva Aórtica
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Valvuloplastia com Balão
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
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Newborn
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article