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Surgical Valvotomy Versus Balloon Valvuloplasty for Congenital Aortic Valve Stenosis: A Systematic Review and Meta ‐ Analysis

View Article: PubMed Central - PubMed

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, I2=22%) or frequency of at least moderate aortic regurgitation at discharge (OR=0.58, 95% CI 0.3–1.3, P=0.09, I2=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.

No MeSH data available.


Kaplan‐Meier curves for survival (A), freedom from aortic valve replacement (B), and freedom from reintervention (C) by intervention in infants <1 year of age at initial intervention. BAV indicates balloon aortic valvuloplasty; SAV, surgical aortic valvotomy.
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jah31661-fig-0004: Kaplan‐Meier curves for survival (A), freedom from aortic valve replacement (B), and freedom from reintervention (C) by intervention in infants <1 year of age at initial intervention. BAV indicates balloon aortic valvuloplasty; SAV, surgical aortic valvotomy.

Mentions: In sensitivity analysis restricted to the subset of infants (<1 year of age) at the time of BAV (n=282) or SAV (n=201), results were unchanged, with no difference between groups in survival (P=0.23) or freedom from valve replacement (P=0.7) (Figure 4A and 4B), but there was more reintervention in the BAV group (P<0.001) (Figure 4C). There was no difference in results when they were stratified by overall Hayden risk of bias score (Figure S1).


Surgical Valvotomy Versus Balloon Valvuloplasty for Congenital Aortic Valve Stenosis: A Systematic Review and Meta ‐ Analysis
Kaplan‐Meier curves for survival (A), freedom from aortic valve replacement (B), and freedom from reintervention (C) by intervention in infants <1 year of age at initial intervention. BAV indicates balloon aortic valvuloplasty; SAV, surgical aortic valvotomy.
© Copyright Policy - creativeCommonsBy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015309&req=5

jah31661-fig-0004: Kaplan‐Meier curves for survival (A), freedom from aortic valve replacement (B), and freedom from reintervention (C) by intervention in infants <1 year of age at initial intervention. BAV indicates balloon aortic valvuloplasty; SAV, surgical aortic valvotomy.
Mentions: In sensitivity analysis restricted to the subset of infants (<1 year of age) at the time of BAV (n=282) or SAV (n=201), results were unchanged, with no difference between groups in survival (P=0.23) or freedom from valve replacement (P=0.7) (Figure 4A and 4B), but there was more reintervention in the BAV group (P<0.001) (Figure 4C). There was no difference in results when they were stratified by overall Hayden risk of bias score (Figure S1).

View Article: PubMed Central - PubMed

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&#8208;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&#8208; and dual&#8208;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&ndash;2.0, P=0.27, I2=22%) or frequency of at least moderate aortic regurgitation at discharge (OR=0.58, 95% CI 0.3&ndash;1.3, P=0.09, I2=54%). Kaplan&ndash;Meier analysis showed no difference in long&#8208;term survival or freedom from aortic valve replacement but significantly more reintervention in the BAV group (10&#8208;year freedom from reintervention of 46% [95% CI 40&ndash;52] for BAV versus 73% [95% CI 68&ndash;77] for SAV, P&lt;0.001). Results were unchanged in a sensitivity analysis restricted to infants (&lt;1&nbsp;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&#8208;invasive approach, and clinical equipoise with respect to more clinically relevant outcomes, these findings support the need for a randomized controlled trial.

No MeSH data available.