Dilatation percutanée des sténoses aortiques critiques néonatales : facteurs prédictifs de ré-intervention

Abstract : Background: Balloon aortic valvulopasty (BAV) is an alternative therapy to surgery in newborns with critical aortic stenosis and has become the first-line treatment in many centers [1-2]. Concerns remain as to restenosis, aortic valve regurgitation and risks of re-intervention [3]. Aims: The aim of the present study was to identify predictors of re-intervention (surgery or catheterization) after BAV of neonatal aortic stenosis. Methods: Monocentric, retrospective study. 36 neonates with congenital aortic valve stenosis, who underwent BAV, were included between 10-2003 and 11-2016. Patients were divided into 2 groups (group 1 : <15 days (n = 23), group 2: >15 days (n = 13)). Median follow-up reached 3 [1-9] years. Immediate success was defined as residual aortic valve gradient < 35mmHg and absence of significant aortic regurgitation. Results: Median age at intervention was 8 [1-45] days, median weight 3.4 [1.1-5.4] Kg. Median balloon/annulus ratio was 1 [0.8-1.2]. Post-procedure mortality was 13.9%. Procedure was successful in 24 patients (66.7%). Freedom from reintervention was 78% at 1 year and 62.5% at 5 years. Age < 15days, were significantly associated with reintervention (p=0.001 and p=0.013, respectively). The support by Alprostadil, presence of a significant residual aortic valve gradient > 35mmHg or significant aortic insufficiency (at the end of the catheterization), and the balloon/annulus ratio was not significantly associated with reintervention in multivariate statistics. Conclusion: BAV remains a valuable alternative to surgical valvotomy in neonatal aortic valve stenosis. Age of the patients and residual gradient were in our study, significantly associated with risk of reintervention.
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Édouard Aries. Dilatation percutanée des sténoses aortiques critiques néonatales : facteurs prédictifs de ré-intervention. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02093248⟩

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