Introduction

Severe congenital aortic valve stenosis (AVS) in infants constitutes a significant therapeutic challenge. Currently, two methods are mostly used as first-line therapy: balloon aortic valvuloplasty (BAV) and surgical aortic valvotomy (SAV). In critically ill neonates, BAV is preferred as a less invasive procedure. If BAV fails, SAV remains an indispensable option.

Aim

To evaluate retrospectively the immediate and long-term outcomes of SAV as a primary procedure or re-intervention (after BAV) in infants with severe AVS.

Material and methods

SAV results were retrospectively analyzed in 23 children (including 3 born prematurely), operated on in the first year of life. Patients were divided into two groups: Gr-I (n = 9) infants with prior BAV and Gr-II (n = 14) infants who underwent SAV as the primary intervention. BAV was performed at a median age of 4 days, while SAV was performed at a median age of 50 days in Gr-I and 33 days in Gr-II. The mean follow-up period was 12.3 years.

Results

Postoperative echocardiography showed a reduction in transvalvular pressure gradient (TVPG) and an increase in left ventricular ejection fraction (LVEF) in both groups. During hospitalization 10 (43.5%) infants developed various complications, which occurred more frequently in Gr-I. After SAV, 4 children (all from Gr-II) required 5 various re-interventions. One patient (Gr-I) died due to septicemia. In follow-up, 22 children were doing well and remained under outpatient supervision.

Conclusions

SAV as the first-line treatment or re-treatment after BAV in infants with severe AVS was associated with satisfactory outcomes. Both methods may complement each other, potentially delaying definitive aortic valve replacement.