Balloon aortic valvotomy through a carotid cutdown in infants with severe aortic stenosis: results of the multi-centric registry

Objectives: The purpose of this study was to evaluate the short and interme diate term results of infants who have undergone balloon aortic valvotomy f rom the carotid arterial approach, and to identify risk factors in those in fants who had a poor outcome. Methods: Between 1988 and 1999, balloon aorti c valvotomy was attempted at four centres in 95 infants with severe aortic stenosis. Echocardiographic and hemodynamic data, and outcome, were analyse d retrospectively. Results: Valvotomy was accomplished in 92 of the 95 infa nts, with a median age of 5 days, a range from 0 to 191 days, and weighing 3.4 kg, with a range from 1.0 to 6.5 kg. Major procedural complications occ urred in 10 infants. Post-procedural aortic regurgitation was severe in 5 p atients. There were 13 early deaths, and 4 late deaths. The period of mean follow-up has been 2.1 years, with a range from 0 to 9.3 years. The actuari al survival at 3 years was 76 +/- 6%. Further interventions were needed in 13 patients, giving a 3-year freedom from reintervention of 67 +/- 6%. The 51 infants who were duct-dependent were further analyzed, and found to have a higher mortality (38%) compared to those infants not dependent on the ar terial duct (5%). Risk factors for a poor outcome in the duct-dependent inf ants were mitral stenosis (p < 0.005), a left ventricle which did not form the cardiac apex (p < 0.005), and an aortic valve with a diameter of less t han 6 mm (p < 0.05). Conclusions: This multi-centric registry shows good re sults in the intermediate term for treating infants with severe aortic valv ar stenosis with balloon valvotomy through a carotid arterial cutdown. Infa nts dependent on prostaglandin had a worse outcome, especially if they had any of the identified risk factors.