Follow up after Balloon Aortic Valvuloplasty from the 1990s - a single centre 10 year cohort

  • Prof Ricardo Samson, University of Arizona, United States
  • Dr Tim Jellyman, Waitakere Hospital, New Zealand
  • Dr Clare O'Donnell, Starship Hospital and Greenlane Clinical Services, New Zealand
  • Dr Tom Gentles, Starship Hospital and Greenlane Clinical Services, New Zealand
  • Dr Nigel Wilson, Starship Hospital and Greenlane Clinical Services, New Zealand

    • Objective: To review long term outcomes from percutaneous Balloon Aortic Valvuloplasty (BAV).

    Methods: Single centre, retrospective audit of all BAVs for aortic stenosis from 1991 to 2000. Valve survival was defined by freedom from repeat BAV or aortic valve surgery.

    Results: 30 children aged 1 month to 18 years underwent BAV. 18 had immediate valve gradient reduction > 50%. Balloon-annulus ratio (BAR) did not correlate with gradient reduction or development of aortic regurgitation (AR). Acute severe AR occurred in 1 patient. Long-term complications: femoral artery occlusion 1, brachial plexus palsy 1.
    Overall survival 8-18 years was 100%. Median survival of the native aortic valve was 5.9 years. 9 required surgery for significant progresive AR, 3 within 2 years of BAV, 6 after 4.2 - 9.5 years.
    4/30 patients developed re-stenosis and underwent repeat BAV 3.7 - 7.6 years after initial BAV. 3 of these 4 required surgery within 6 months (1 for inadequate stenosis relief, 2 for significant AR). 6 others underwent surgery for persistent or recurrent stenosis; 1 - 5.6 years after BAV.
    Overall 20 of 30 required subsequent aortic valve surgery or repeat BAV. Freedom from re-intervention at 5 years was 53% and 10 years was 27%.

    Conclusions: BAV is a palliative procedure for aortic stenosis delaying requirement for further procedures over 5 years in the majority of cases. Aortic regurgitation can be progressive late following BAV and in this series was as frequent as recurrent aortic stenosis.