Surgical and Transcatheter Treatments in Children with Congenital Aortic Stenosis

Background For patients with congenital aortic valve stenosis (AVS), comprehensive analysis of surgical aortic valvuloplasty (SAV) or balloon dilation (BD) is scarce and remains controversial. Methods This study reviewed AVS data (aortic peak gradient, aortic insufficiency, and survival and reoperation) for patients who were suitable for biventricular repair at our center in 2008 to 2018. Patients were categorized into two subgroups based on age (<= 3 or >3 months). Results A total of 194 patients were treated, including 124 with SAV and 70 with BD. Resulting data revealed that residual aortic gradient at discharge was worse for BD ( p =0.001). While for patients younger than 3 months, the relief of AVS was comparable between the two groups ( p =0.624). There was no significant difference in time-related survival between the two groups (log-rank p =0.644). Multivariate analysis demonstrated that preoperative left ventricular end-diastolic dimension predicted early death ( p =0.045). Survival in the two groups after 10 years was 96.8% in SAV and 95.7% in BD ( p =0.644). Freedom from reoperation after 10 years was 58.1% in SAV and 41.8% in BD patients ( p =0.01). There was no significant difference in freedom from reoperation between SAV and BD in patients younger than 3 months ( p =0.84). Multivariate analysis indicated that residual aortic peak gradient was predictive of reoperation ( p =0.038). Conclusion Both methods achieved excellent survival outcomes at our center. SAV achieved superior gradient reduction and minimized the necessity for reoperation. For patients younger than 3 months, BD rivaled SAV both in aortic stenosis relief and freedom from reoperation.