Abstract 11511: Long-Term Outcomes of Transcatheter Aortic Valvuloplasty in Infants: A Study from the Pediatric Cardiac Care Consortium

Abstract

Introduction: Long-term outcomes of aortic stenosis (AS) after balloon aortic valvuloplasty (BAV) in infancy are scarce. Here, we report the 25-year outcomes after the first BAV in infants enrolled in the Pediatric Cardiac Care Consortium (PCCC), a US-based registry of pediatric cardiac interventions. Methods: We queried the PCCC for patients undergoing BAV in infancy between 1982 and 2003. Outcomes were tracked through 2019 in the PCCC and by linkage with the National Death Index and the Organ Procurement and Transplantation Network. Cases dependent on ductus arteriosus at the time of BAV were deemed critical and procedural outcomes were defined as optimal if residual valve gradient was &lt30mmHg and no more than mild insufficiency reported. Reinterventions were tracked in PCCC through 2011. Transplant-free survival (TFS) post initial BAV is described by Kaplan-Meier plots . Results: The cohort included 316 patients: males 75.3%, median age 0.6 months (IQR: 0.1 - 2) at the time of the BAV. Of them, 95 had critical AS and 187 had optimal procedural outcome. A total of 289 (91.5%) survived to hospital discharge. Over a median follow-up time of 21.7 years (IQR: 18.9, 24.6), 3 patients underwent transplantation and 17 died, with a 25-year TFS of 92.4% (95%CI: 89.0-96.0%). Presence of critical AS and procedural outcome did not affect long-term outcomes (Figure 1). One hundred thirteen patients underwent at least one transcatheter or surgical reintervention through 2011: 48 (42%) had critical AS and 59 (52%) had suboptimal outcome after the first BAV (relative risk of reintervention 1.26 (95%CI: 0.94, 1.69) and 1.98 (95%CI: 1.48, 2.64) respectively). Conclusions: Infants undergoing BAV have favorable 25-year survival independent of the critical nature of the AS and the lack of optimal outcome at discharge. Patients with suboptimal result were more likely to require reintervention.