Diminished left ventricular function is associated with poor mid-term outcomes in neonates after balloon aortic valvuloplasty

Abstract

Objectives: We studied outcomes of neonatal aortic valvuloplasty to determine the risk factors for poor outcomes.

Background: Balloon aortic valvuloplasty (BAV) is the primary therapy for neonates with severe aortic stenosis (AS). Limited data are available on the mid-term and long-term outcomes in this population, and reported risk factors for poor outcomes vary among studies.

Methods: We reviewed all cases of BAV in neonates in our institution between 1998 and 2009. We reviewed patient characteristics, preintervention echocardiographic, and procedural details. We tracked repeat BAV, aortic valve replacement (AVR), and death/transplant. Kaplan-Meier and Cox regression analyses were performed. Changes in dimensions of left heart structures post-BAV were also studied.

Results: Forty-eight neonates were included-of these, 30 (62%) had critical AS. There was one procedural death. The remaining 47 neonates were followed for 4.8 ± 4.4 years. Repeat BAV was performed in 19 (40%) neonates; AVR was performed in 9 (19%), and death/transplant occurred in 4 (8%) neonates. Multivariate analysis revealed that lower LV shortening fraction pre-BAV, higher pre-BAV and final valve gradient, and need for inotropes were associated with poor long-term outcomes. LV diastolic and systolic dimensions normalized over time, and left heart structures improved in size early and late after BAV.

Conclusions: Neonatal BAV is associated with low mortality. Lower LV shortening fraction pre-BAV is associated with risk of future interventions, while repeat valvuloplasty is safe and effective for recurrent AS. There is significant improvement in dimensions of the LV and aortic valve annulus following BAV.