Abstract 14392: Aortic Balloon Valvuloplasty in the 21st Century: Procedural Success, Efficacy and Adverse Events: Results of a Multicenter Registry (C3PO)
Introduction: Balloon aortic valvuloplasty (BAV) is the treatment of choice for most pediatric pts with valvar aortic stenosis (AS). Since first described (1984) improvements in technologies and procedural techniques have occurred. Current reports of such data are lacking. We report prospective data from a large multi-center series documenting efficacy and safety of BAV in the current era.
Methods: Patient and procedural characteristics and adverse events (AE) data on pts undergoing BAV from 2/07 to 12/09 were collected prospectively from 8 pediatric institutions using the Congenital Cardiac Catheterization Outcomes Project (C3PO) registry. Pts were divided by age into <1 mo (Gp 1) and >1 mo (Gp 2). Single ventricle pts were excluded. Acute procedural success was defined as residual peak systolic gradient (RPSG) <40 mmHg and < 2 grade increase in aortic insufficiency (AI). AE were graded on a scale 1–5 with ≤ mild AE (1–2) and moderate-catastrophic AE (3–5).
Results: There were 87 pts in Gp 1 (median wt 3.4 kg [IQR 3.0, 3.6]), and 156 pts in Gp 2 (20.9 kg [6.6, 48.2]). Isolated AS was present in 64% of pts in both groups. In Gp 1, vessel access was via femoral artery (FA) in 77 pts, umbilical artery in 10, umbilical vein in 7, and carotid artery in 2. FA was used in all but 1 pt in Gp 2. BAV was elective for 22% of Gp1 pts and 89% of Gp2 pts. Efficacy data was recorded for 65/87 pts in Gp 1 and 117/156 in Group 2. Procedural success was achieved in 45/65 (69%) Gp1 pts with RPSG >40 mmHg in 17% pts and ≥ 2 grade increase in AI in 14%. For Gp2, BAV was successful in 97/117 pts (80%) with RPSG >40 mmHg in 15% and ≥ 2 grade increase in AI in 5%. AE occurred in 28/87 (32%) Gp 1 pts, with 43% grade 1–2 and 57% grade 3–4 (vascular injury and AI most common with 2 pts requiring surgery for severe AI). There were no deaths. In Gp 2, AE occurred in 27/156 (17%) pts with 44% grade 3–4 (arrhythmias and AI most common; 1 emergent surgery for MR). There was 1 death in Gp2. AE were considered not preventable in 54% of pts in Gp 1 and 68% in Gp 2.
Conclusion: In the current era BAV can be performed with good procedural success irrespective of age. BAV in pts <1mo are more often non-elective and have higher risk of grade 3–4 AE. Most common AE include vascular injury in pts < 1 mo and worsening AI at all ages. Emergent surgery and death are rare for all ages.
- Aortic valve stenosis
- Valvular heart disease
- Interventional cardiology
- Pediatric cardiology
- © 2010 by American Heart Association, Inc.