Archives of Cardiovascular Diseases Supplements | 2021
Critical aortic stenosis in neonates: Balloon valvuloplasty versus surgical valvotomy
Abstract
Objectives Congenital aortic valvular stenosis in neonates is a life-threatening condition requiring urgent management. Therapeutic strategy remains controversial between balloon valvuloplasty (BV) and surgical valvulotomy (SV). We reviewed our long-term single-center experience of neonatal aortic stenosis management and compared aortic valve outcomes regarding BV versus SV. Methods Between 1990 and 2020, 137 patients underwent aortic stenosis treatment (SV [n\xa0=\xa083] and BV [n\xa0=\xa054]) with a median age of 5.5\xa0days (range: 0 to 30\xa0days) and a median weight of 3\xa0kg (range: 1.8 to 4.8\xa0kg). Procedure strategy was decided according to the surgeon availability especially at the beginning of the study. Additionally, there was a traditional local protocol favoring balloon in case of left ventricular dysfunction like in many centers. Results The median follow-up was 6.7\xa0years (up to 28y, 88% complete). We did not report any operative death but the intra-hospital mortality was notably greater for patients after balloon procedure (20.3%) versus SV group (8.4%). The one-year and ten-year patient survival was respectively 90 and 89% in SV group versus 75 and 69% in BV group (P\xa0 Fig. 1 ). Conclusion Long-term survival and freedom from reintervention are excellent after surgical valvotomy. However, poor results are obtained when patients had initial left ventricular dysfunction or multiple left ventricular outflow lesions.