Surgical Valvotomy Versus Balloon Valvuloplasty for Congenital Aortic Valve Stenosis: A Systematic Review and Meta-Analysis.
Abstract
BACKGROUND: Optimal initial treatment for congenital aortic valve stenosis in children
remains unclear between balloon aortic valvuloplasty (BAV) and surgical aortic valvotomy
(SAV). METHODS AND RESULTS: We performed a contemporary systematic review and meta-analysis
to compare survival in children with congenital aortic valve stenosis. Secondary outcomes
included frequency of at least moderate regurgitation at hospital discharge as well
as rates of aortic valve replacement and reintervention. Single- and dual-arm studies
were identified by a search of PubMed (Medline), Embase, and the Cochrane database.
Overall 2368 patients from 20 studies were included in the analysis, including 1835
(77%) in the BAV group and 533 (23%) in the SAV group. There was no difference between
SAV and BAV in hospital mortality (OR=0.98, 95% CI 0.5-2.0, P=0.27, I(2)=22%) or frequency
of at least moderate aortic regurgitation at discharge (OR=0.58, 95% CI 0.3-1.3, P=0.09,
I(2)=54%). Kaplan-Meier analysis showed no difference in long-term survival or freedom
from aortic valve replacement but significantly more reintervention in the BAV group
(10-year freedom from reintervention of 46% [95% CI 40-52] for BAV versus 73% [95%
CI 68-77] for SAV, P<0.001). Results were unchanged in a sensitivity analysis restricted
to infants (<1 year of age). CONCLUSIONS: Although higher rates of reintervention
suggest improved outcomes with SAV, indications for reintervention may vary depending
on initial intervention. When considering the benefits of a less-invasive approach,
and clinical equipoise with respect to more clinically relevant outcomes, these findings
support the need for a randomized controlled trial.
Type
Journal articleSubject
aortic surgeryaortic valve stenosis
balloon aortic valvuloplasty
congenital heart defects
meta‐analysis
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https://hdl.handle.net/10161/13548Published Version (Please cite this version)
10.1161/JAHA.116.003931Publication Info
Hill, Garick D; Ginde, Salil; Rios, Rodrigo; Frommelt, Peter C; & Hill, Kevin D (2016). Surgical Valvotomy Versus Balloon Valvuloplasty for Congenital Aortic Valve Stenosis:
A Systematic Review and Meta-Analysis. J Am Heart Assoc, 5(8). 10.1161/JAHA.116.003931. Retrieved from https://hdl.handle.net/10161/13548.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Kevin Dennis Hill
Professor of Pediatrics
Clinical research including outcomes, drug and device trials, short and long term
safety and efficacy of interventions and hemodynamic effects of interventions.

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