Svetlana A. Zubkova, Elena G. Levchenko , Andrey A. Svobodov, Margarita R. Tumanyan, Manolis G. Pursanov

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – B

Abstract

Materials: We made a retrospective analysis of 335 medical histories and 320 case-records of patients operated on for critical aortic stenosis before the age of 1 year over the period of 2005-2015 years in the BSCCS (A.N. Bakoulev Scientific Center for Cardiovascular Surgery) by using percutaneous balloon aortic valvuloplasty (BAV).

Results: At the time of surgery the mean age was 71 [15…133] days, weight 5,1 [3,6…6,7] kg, z score of the aortic annulus 0,91 [0,23…1,56], the peak systolic gradient across the aortic valve 78 [68…90] mmHg. After percutaneous balloon aortic valvuloplasty the peak systolic gradient across the aortic valve, measured during the operation, became 20 [12…25] mmHg. After 3 [2…5] days 320 patients have been discharged with the peak systolic gradient across the aortic valve 30 [24…38] mmHg and aortic regurgitation 1 [0,5…1,5] degree. The mortality was 4,5% (n= 15).

Risk factors of mortality were a critical condition on the moment of admission (odds ratio (OR) 52,7, 95% confidence interval (CI) 0.019-0.255, p=0.000), weight ˂3.3 kg (OR 10,5, 95% CI 3,549-31,068, p=0,000), age ˂18 days (OR 20,9, 95% CI 4,606-94,541; p=0,000) and z score of the aortic annulus ˂+0,3 (OR 5,89, 95% CI 2,047-16,949; p=0,001)

The period of observation in catamnesis was 4 [2,5…6,9] years. Reoperations because of stenosis and/or aortic valve regurgitation was performed in 37 children (11,6%) at the age of 1.58 [4,1 0,5...] years. Risk factors for reoperation on the valve were the peak systolic gradient across the aortic valve at discharge after the primary BAV more than 44 mmHg (OR 7,5, 95% CI 0,067-0,308, p=0.000) and z-score of the aortic annulus ˂+0,3 (OR 3,072, 95% CI 1,504-7,645, p=0.007).

Conclusions: BAV of the aorta is an effective and safe method for treatment of aortic stenosis in patients of the first year of life.