Acute Success of Balloon Aortic Valvuloplasty in the Current Era: A National Cardiovascular Data Registry Study.
OBJECTIVES: The aim of this study was to evaluate practice patterns and outcomes of a contemporary group of patients undergoing balloon aortic valvuloplasty (BAV) for congenital aortic stenosis (AS).
BACKGROUND: BAV is the most common treatment for isolated congenital AS.
METHODS: Within the IMPACT (Improving Pediatric and Adult Congenital Treatments) Registry, all BAV procedures performed between January 2011 and March 2015 were identified. Procedures were separated into those performed for critical versus noncritical AS. Outcomes were stratified into optimal, adequate, and inadequate, with optimal and adequate outcomes defining "successful" procedures. Multivariate logistic regression was used to identify patient and procedural characteristics associated with unsuccessful BAV. Mortality and adverse events rates were compared across patient cohorts.
RESULTS: Of the 1,026 isolated BAV procedures captured in IMPACT, 718 (70%) were "successful." Success rates were 70.9% for noncritical AS (n = 916) and 62.7% for critical AS (n = 110). Multivariate analysis revealed that prior cardiac catheterization, mixed valve disease, baseline aortic valve gradient >60 mm Hg, baseline aortic insufficiency greater than mild, presence of a trainee, and multiple balloon inflations were associated with unsuccessful BAV in the noncritical AS cohort. There were no factors associated with unsuccessful procedures in the critical AS group. No procedural deaths occurred, but 2.4% of patients did not survive to hospital discharge. Adverse events occurred in 15.8% of all cases and were more frequent in procedures performed for critical AS (30.0% vs. 14.1%; p < 0.001).
CONCLUSIONS: BAV is an effective treatment for congenital AS with low rates of mortality and adverse events. Patients with critical AS have a higher risk for procedure-related adverse events.
JACC Cardiovasc Interv
Adolescent; Aortic Valve; Aortic Valve Stenosis; Balloon Valvuloplasty; Bicuspid Aortic Valve Disease; Chi-Square Distribution; Child; Child, Preschool; Female; Heart Valve Diseases; Hemodynamics; Hospital Mortality; Humans; Infant; Infant, Newborn; Logistic Models; Male; Multivariate Analysis; Practice Patterns, Physicians'; Recovery of Function; Registries; Risk Factors; Time Factors; Treatment Outcome; United States
aortic valvuloplasty; catheterization; congenital cardiology
Boe, B. A., Zampi, J. D., Kennedy, K. F., Jayaram, N., Porras, D., Foerster, S. R., Armstrong, A. K. Acute Success of Balloon Aortic Valvuloplasty in the Current Era: A National Cardiovascular Data Registry Study. JACC Cardiovasc Interv 10, 1717-1726 (2017).