Clinical study
Midterm results of balloon dilation of congenital aortic stenosis: Predictors of success

https://doi.org/10.1016/0735-1097(95)00608-7Get rights and content
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Objectives.

We evaluated patient and procedural characteristics that influence the midterm success of balloon dilation of congenital aortic stenosis.

Background.

Balloon dilation is a new treatment for congenital aortic stenosis. Factors that influence midterm success are unknown.

Methods.

We performed a retrospective review of 148 children >1 month old who underwent balloon dilation for aortic stenosis.

Results.

Balloon dilation was successful in 87% of patients, with a procedural mortality rate of 0.7%. The average immediate peak to peak gradient reduction was 56.4 ± 19.9% (mean ± SD). Prior valvotomy was the only factor that significantly reduced the immediate gradient reduction after dilation (47.1 ± 21.8% vs. 57.8 ± 19.6%, p < 0.01). Survival after dilation was 95% at 8 years. Seventy-five percent of patients were free of repeat intervention 4 years after dilation, whereas 50% remained free of repeat intervention at 8 years. Asymmetrically thick valve leaflets (risk ratio [RR] 0.17, p < 0.01) and prior aortic valvotomy (RR 0.35, p = 0.02) decreased the risk of repeat intervention. Aortic regurgitation grade ≥3 (RR 4.27, p = 0.04) and residual gradient after dilation (RR 1.63 for 10 mm Hg, p < 0.01) increased the risk.

Conclusions.

The 8-year survival rate after dilation was 95%, with 50% of patients free of repeat intervention. Factors that increased the risk for repeat intervention included symmetrically thin or thick aortic valve leaflets, regurgitation grade ≥3 after dilation and a high residual gradient after dilation. The incidence of repeat intervention after dilation was high owing to its palliative nature.

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This study was funded by the Children's Heart Foundation, Boston, Massachusetts.

All editorial decisions for this article, including selection of referees, were made by a Guest Editor. This policy applies to all articles with authors from the University of California, San Francisco.