Abstract 19605: Aortic Valve Morphology Influences Outcomes of Balloon Aortic Valvuloplasty in Children with Congenital Aortic Stenosis
Background: In isolated congenital aortic valve stenosis (AS) early and late outcomes following BAV vary widely despite near uniform procedural and technical factors. Anatomic factors may account for some of this variability in outcomes. We sought to identify morphologic factors that may influence outcomes of BAV.
Hypothesis: Aortic valve anatomy influences outcomes after BAV.
Methods: We reviewed all pts who underwent BAV at two large pediatric institutions between 2007-2013. Pre- and post-BAV echocardiography (echo) was reviewed. Anatomic indices including valve leaflet excursion, valve annulus area (AA), valve orifice area (OA), valve morphology, and raphe (fusion) length were measured on all pre- and post-BAV echo. Primary endpoint was favorable tear (FT), defined as tear along a commissure. Unfavorable tear (UT) was defined as tear into a leaflet, and no tear (NT) defined as no visible tear. Secondary endpoint was aortic insufficiency increase ≥2 degrees (AI+).
Results: A total of 88 pts had complete clinical and echo data available, of whom 34 (39%) were neonates at the time of BAV. FT was noted in 56 (58%) pts, UT noted in 16 pts (18%), and NT in 16 pts (18%). FT was more common in functionally unicuspid valves (p=0.02), with lower OA/AA ratio (p=0.003), and in pts with greater fusion length (p=0.042). OA was highly correlated with fusion length (p<0.001) and aortic root diameter (p<0.001) but not with leaflet excursion (p=0.68). Of 16 pts with AI+, 11 were in the UT cohort (11/16), while 5 were in the FT cohort (5/56) (OR for AI+ 13.7, 3.8-50). Pts with larger OA (p=0.007) and less fusion (p=0.032) were more likely to develop UT. The cath gradient fell from a median of 57mmHg (IQR 48-75) to 23mmHg (IQR 16-31) after BAV ; gradient reduction was lower in UT (23.2, 12-33) than in FT (30.9, 24-37) or UT (39.0, 27-51) (p=0.042). Multivariate analysis demonstrated that functionally unicuspid valve morphology (p=0.048) and lower OA (p=0.030) were associated with FT.
Conclusion: Favorable and unfavorable tears post-BAV are associated with similar gradient relief but discrepant degrees of AI. FT and UT may be predictable based upon valve morphology. Enhanced BAV patient selection with careful assessment of anatomic valve metrics may result in improved outcomes following BAV.
Author Disclosures: C.J. Petit: None. K. Gao: None. B.H. Goldstein: None. S.M. Lang: None. S.I. Kim: None. R. Sachdeva: None.
- © 2014 by American Heart Association, Inc.