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(Circulation. 2001;104:I-152.)
© 2001 American Heart Association, Inc.

Surgery for Congenital Heart Disease

Are Outcomes of Surgical Versus Transcatheter Balloon Valvotomy Equivalent in Neonatal Critical Aortic Stenosis?

Brian W. McCrindle, MD, MPH; Eugene H. Blackstone, MD; William G. Williams, MD; Rekwan Sittiwangkul, MD; Thomas L. Spray, MD; Anthony Azakie, MD; Richard A. Jonas, MD; , the members of the Congenital Heart Surgeons Society

Divisions of Cardiology and Cardiovascular Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada (B.W.M., W.G.W., R.S., A.A.); the Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio (E.H.B.); the Division of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pa (T.L.S.); and the Department of Cardiac Surgery, The Children’s Hospital, Boston, Mass (R.A.J.).

Reprint requests to Brian W. McCrindle, MD, The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8. E-mail brian.mccrindle{at}sickkids.on.ca

Background— For neonates with critical aortic valve stenosis who are selected for biventricular repair, valvotomy can be achieved surgically (SAV) or by transcatheter balloon dilation (BAV).

Methods and Results— Data regarding 110 neonates with critical aortic valve stenosis were evaluated in a study by the Congenital Heart Surgeons Society from 1994 to 1999. Reduced left ventricular function was present in 46% of neonates. The initial procedure was SAV in 28 patients and BAV in 82 patients. Mean percent reduction in systolic gradient was significantly greater with BAV (65±17%) than SAV (41±32%; P<0.001). Higher residual median gradients were present in the SAV versus BAV group (36 mm Hg [range, 10 to 85 mm Hg] versus 20 mm Hg [0 to 85 mm Hg], P<0.001). Important aortic regurgitation was more often present after BAV (18%) than SAV (3%; P=0.07). Time-related survival after valvotomy was 82% at 1 month and 72% at 5 years, with no significant difference for SAV versus BAV, even after adjustment for differences in patient and disease characteristics. Independent risk factors for mortality were mechanical ventilation before valvotomy, smaller aortic valve annulus (z score), smaller aortic diameter at the sinotubular junction (z score), and a smaller subaortic region. A second procedure was performed in 46 survivors. Estimates for freedom from reintervention were 91% at 1 month and 48% at 5 years after the initial valvotomy and did not differ significantly between groups.

Conclusions— SAV and BAV for neonatal critical aortic stenosis have similar outcomes. There is a greater likelihood of important aortic regurgitation with BAV and of residual stenosis with SAV.

Key Words: balloon • surgery • heart defects, congenital • valves • stenosis