Abstract 2205: Exercise Restriction and Sudden Unexpected Death After Balloon Valvuloplasty for Congenital Aortic Stenosis
Background: Exercise restriction is recommended for patients with congenital aortic stenosis (AS) due to a perceived increased risk of sudden unexpected death (SD). However, there is little evidence that exercise increases risk in this population, and such recommendations are at odds with the known beneficial effects of regular exercise in maintaining cardiovascular health. We sought to determine the incidence and risk factors of SD in pts who underwent balloon aortic valvuloplasty (BAVP) for severe AS.
Methods: Review of pts who underwent BAVP for congenital AS with biventricular circulation at Children’s Hospital Boston. Exercise restriction status was ascertained for those ≥ 4 years of age, and pts were censored at aortic valve replacement (AVR) or transplant. Vital status and causes of death were verified for all pts with no follow-up data for > 5 years (n=49) using the National Death Index.
Results: From 1984 –2008, 500 pts underwent BAVP with a median subsequent follow-up of 12.7 years (range 0 –24.5) and total 6131 patient-years follow-up. Median age at first BAVP was 1.8 years (range 0 –39). There were 63 deaths over the study period, with SD in 6, 5 of which occurred in those ≤ 18 months of age. For pts ≥ 4 years of age at most recent follow-up (n=423), median follow-up after BAVP was 14.6 years for 5998 patient-years follow-up; censoring at AVR or transplant, 13.3 years and 5502 patient-years, although SD did not occur following these. Exercise restriction was prescribed in 184 pts (44%, 2528 patient-years); not restricted in 221 (52%, 2699 patient-years); and insufficient data in 18. There were 20 deaths in this cohort of 423 pts, with 1 SD (pt died during sleep, exercise restricted), for an incidence of 0.18/1000 patient-years (95%CI, 0.01–1.01/1000).
Conclusions: Sudden unexpected death is extremely rare after BAVP for congenital AS. No beneficial effect of exercise restriction was observed in this longitudinal cohort with 6000 patient-years of follow-up.