721-2 Aortic Valve Repair and Replacement After Balloon Aortic Valvuloplasty in Children

Abstract

Little is known about the incidence, indications and results of surgical repair or replacement of the aortic valve following balloon valvuloplasty for congenital aortic stenosis in children. This study was designed to evaluate patterns of failure requiring surgery after balloon aortic valvuloplasty (BAli.) of congenital AS and to review our experience with successful repair, rather than replacement, of some aortic valves after BAV. From 1986 to 1994, 54 patients with congenital AS aged 1 day-27 years (mean ± sd; 8 ± 6 yrs) underwent BAV. Eighteen patients (33%) required surgery a mean of 33 ± 25 mos (range 1 to 80 mos) following BAV. because of severe AI in 10 patients and recurrent or residual AS in 8 patients. Severe AI was invariably due to avulsion of a cusp from the annulus with resulting cusp prolapse and insufficiency. Actuarial freedom from surgical intervention was 90 ± 4% at 1 year, 79 ± 6% at 3 years, and 64 ± 7% at 6 years. The need for aortic valve surgery was unrelated to age at the time of BAV. Surgical intervention consisted of valve replacement in 11 patients and aortic valve repair in 7 patients. Repair techniques included reattachment of an avulsed cusp to the aortic annulus, relief of commissural fusion, and debridement of thickened cusps. All survived operation and are alive 23 ± mos (range 2–44 mos) following aortic valve operation. LV outflow gradient has been well relieved in all patients undergoing valve replacement. The 7 valve repair patients have been followed 17 ± 10 mos (range 4–33 mos). Echocardiographic follow-up of the valve repair patients revealed mild levels of residual AS and mild (1–2+) AI in all patients. Aortic valve surgery is required in 5–10% of patients yearly following BAli. and appears to be unrelated to age at the time of BAV. AI predominates over AS as an indication for operative intervention. Valve repair can be applied in some patients following BAV. with good intermediate-term results and may delay the need for aortic valve replacement.