Balloon dilation versus surgery for severe neonatal aortic valve stenosis: A matched comparison

Abstract

Two therapeutic approaches exist for first-line treatment of neonatal severe/critical aortic valve stenosis: percutaneous balloon dilatation and surgical valvuloplasty. For both interventions, the early and long-term results are satisfactory. Previous reports have failed to show clear superiority of one versus the other procedure. In la Timone university hospital (Marseille), balloon dilation is the usual therapeutic approach for neonatal critical/severe aortic valve stenosis. In Necker university hospital (Paris), surgical valvuloplasty remains the preferred option. The aim of our current study is to compare the 2 populations using propensity scores matching. Patients aged < 1 month who underwent percutaneous aortic valve balloon dilation for aortic valve stenosis in Marseille between 2003 and 2020, are included. Patients with borderline left ventricle or hypoplastic left heart syndrome are excluded. Balloon patients will be matched based on age, weight, duct-dependency, left ventricular function, aortic valve morphology and mitral function, with patients who underwent surgical aortic valvuloplasty in Necker (Paris). Early complications, survival, freedom from reintervention, residual stenosis and regurgitation will be retrospectively collected from hospital charts. Initial diagnosis and residual lesions will be confirmed by reviewing echocardiography studies. The primary outcome will be the all-cause mortality. The secondary outcomes will be reintervention, aortic valve replacement, presence of significant valve stenosis or insufficiency at latest follow-up. The results will be available in June 2021. Balloon dilation and surgical valvuloplasty are both efficient procedures for early relief of neonatal aortic stenosis. In case of superiority of one of the techniques, our current practice may need to be questioned and adapted. The complementary aspect of the 2 treatment strategies may also be highlighted.