Objective. To compare neonates with cardiac failure treated either by surgical commisurotomy or transcatheter balloon dilation for critical aortic stenosis.
Methods. Between 1998 and 2008, 16 neonates with aortic valve stenosis underwent surgical commisurotomy (n=7) or transcatheter balloon dilation (n=9). Two of them who underwent balloon dilation were excluded because they had severe aortic valve stenosis without cardiac failure. All the 14 remaining patients had signs of heart failure with either severe left ventricular dysfunction and/or need for prostaglandin E1 infusion.
Results. Median age and weight at intervention were 8(1-30) days and 3.1(2.5-4.5) kg, respectively. Median aortic valve Zscore was –1.1(-4 to +0.9). Both surgery and balloon valvuloplasty were successful in reducing transvalvular mean Doppler gradient from 56.3±25.2 to 21.3±12.3mmHg with no significant difference between the two methods (p=0.4). Two patients died, one after balloon dilation from respiratory failure due to tracheal stenosis and one after surgery with cardiac failure and persistent left ventricular dysfunction. Postprocedural aortic regurgitation was absent in 7 patients, minimal in 4 and moderate in 3, with no difference between transcatheter and surgical therapy (p=0.7). Mean intensive care stay was significantly shorter for patients with balloon dilatation (2.2±1.6 versus 13.8±12days, p=0.05). There were two late reinterventions on the aortic valve (Ross procedure) after surgical commisurotomy.
Conclusion. Transcatheter balloon dilation and surgical commisurotomy have similar short term results, with earlier recovery and shorter intensive care stay with balloon dilation. Longer follow-up is needed to compare long-term results for the two procedures.