Are outcomes of surgical versus transcatheter balloon valvotomy equivalentin neonatal critical aortic stenosis?

Background-For neonates with critical aortic valve stenosis who are selecte d for biventricular repair, valvotomy can be achieved surgically (SAV) or b y transcatheter balloon dilation (BAV). Methods and Results-Data regarding 110 neonates with critical aortic valve stenosis were evaluated in a study by the Congenital Heart Surgeons Society from 1994 to 1999. Reduced left ventricular function was present in 46% of neonates. The initial procedure was SAV in 28 patients and BAV in 82 patie nts. Mean percent reduction in systolic gradient was significantly greater with BAV (65 +/- 17%) than SAV (41 +/- 32%; P <0.001). Higher residual medi an gradients were present in the SAV versus BAV group (36 mm Hg [range, 10 to 85 mm Hg] versus 20 mm Hg [0 to 85 mm Hg], P <0.001). Important aortic r egurgitation was more often present after BAV (18%) than SAV (3%; P=0.07). Time-related survival after valvotomy was 82% at I month and 72% at 5 years , with no significant difference for SAV versus BAV, even after adjustment for differences in patient and disease characteristics. Independent risk fa ctors for mortality were mechanical ventilation before valvotomy, smaller a ortic valve annulus (z score), smaller aortic diameter at the sinotubular j unction (z score), and a smaller subaortic region. A second procedure was p erformed in 46 survivors. Estimates for freedom from reintervention were 91 % at I month and 48% at 5 years after the initial valvotomy and did not dif fer significantly between groups. Conclusions-SAV and BAV for neonatal critical aortic stenosis have similar outcomes. There is a greater likelihood of important aortic regurgitation w ith BAV and of residual stenosis with SAV.