Comparative long-term results of surgery versus balloon valvuloplasty for pulmonary valve stenosis in infants and children.

Details

Serval ID
serval:BIB_29718
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Comparative long-term results of surgery versus balloon valvuloplasty for pulmonary valve stenosis in infants and children.
Journal
Annals of Thoracic Surgery
Author(s)
Peterson C., Schilthuis J.J., Dodge-Khatami A., Hitchcock J.F., Meijboom E.J., Bennink G.B.
ISSN
0003-4975
Publication state
Published
Issued date
2003
Volume
76
Number
4
Pages
1078-1083
Language
english
Notes
Publication types: Comparative Study ; Journal Article
Abstract
BACKGROUND: We compared the long-term results of surgical valvotomy (S) versus balloon valvuloplasty (BV) for pulmonary valve stenosis in infants and children. METHODS: Results after surgical pulmonary valvotomy (with concomitant ASD/VSD closure) (n = 62, age 2.9 +/- 3.5 years) and balloon valvuloplasty (n = 108, age 3.6 +/- 3.9 years) were analyzed. Transvalvular mean pressure gradient decrease, freedom from reintervention for restenosis, pulmonary valve insufficiency, and tricuspid valve insufficiency were considered. RESULTS: Mean pressure gradient decreased significantly more in the surgical group (from 64.8 +/- 30.8 mm Hg to 12.8 +/- 9.8 mm Hg at a mean follow-up of 9.8 years) than after BV (decreasing from 66.2 +/- 21.4 mm Hg to 21.5 +/- 15.9 mm Hg after a mean of 5.4 years; p < 0.001). Moderate pulmonary valve insufficiency occurred in 44% after surgery, and in 11% after BV (p < 0.001). Tricuspid valve insufficiency occurred in 2% after surgery, and in 5% after BV. Restenosis occurred in 3 surgical patients (5.6%), 2 patients required reoperation, and 1 patient required a balloon valvotomy. Restenosis developed in 13 BV patients (14.1%): 6 patients were redilated and 7 patients required surgery. Surgical valvotomy led to significantly less reinterventions than balloon valvuloplasty (p < 0.04). CONCLUSIONS: Surgical relief of pulmonary valve stenosis produces lower long-term gradients and results in longer freedom from reintervention. Balloon valvuloplasty may remain, despite these results, the preferred therapy for isolated pulmonary valve stenosis, because it is less invasive, less expensive, and requires a shorter hospital stay. Surgery should remain the exclusive form of therapy in the presence of concomitant intracardiac defects, which need to be addressed.
Keywords
Balloon Dilatation, Child, Preschool, Follow-Up Studies, Heart Septal Defects, Atrial/complications, Heart Septal Defects, Ventricular/complications, Humans, Infant, Pulmonary Valve/surgery, Pulmonary Valve Stenosis/surgery, Recurrence, Retrospective Studies
Pubmed
Web of science
Create date
19/11/2007 12:27
Last modification date
20/08/2019 13:09
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