Open AccessSurgical Valvotomy Versus Balloon Valvuloplasty for Congenital Aortic Valve Stenosis: A Systematic Review and Meta‐Analysis
Author(s) -
Hill Garick D.,
Ginde Salil,
Rios Rodrigo,
Frommelt Peter C.,
Hill Kevin D.
Publication year - 2016
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.116.003931
Subject(s) - medicine , stenosis , cardiology , balloon , aortic valvuloplasty , balloon valvuloplasty , aortic valve stenosis , aortic valve , meta analysis , surgery
Background Optimal initial treatment for congenital aortic valve stenosis in children remains unclear between balloon aortic valvuloplasty ( BAV ) and surgical aortic valvotomy ( SAV ). Methods and Results We performed a contemporary systematic review and meta‐analysis to compare survival in children with congenital aortic valve stenosis. Secondary outcomes included frequency of at least moderate regurgitation at hospital discharge as well as rates of aortic valve replacement and reintervention. Single‐ and dual‐arm studies were identified by a search of PubMed (Medline), Embase, and the Cochrane database. Overall 2368 patients from 20 studies were included in the analysis, including 1835 (77%) in the BAV group and 533 (23%) in the SAV group. There was no difference between SAV and BAV in hospital mortality ( OR =0.98, 95% CI 0.5–2.0, P =0.27, I 2 =22%) or frequency of at least moderate aortic regurgitation at discharge ( OR =0.58, 95% CI 0.3–1.3, P =0.09, I 2 =54%). Kaplan–Meier analysis showed no difference in long‐term survival or freedom from aortic valve replacement but significantly more reintervention in the BAV group (10‐year freedom from reintervention of 46% [95% CI 40–52] for BAV versus 73% [95% CI 68–77] for SAV , P <0.001). Results were unchanged in a sensitivity analysis restricted to infants (<1 year of age). Conclusions Although higher rates of reintervention suggest improved outcomes with SAV , indications for reintervention may vary depending on initial intervention. When considering the benefits of a less‐invasive approach, and clinical equipoise with respect to more clinically relevant outcomes, these findings support the need for a randomized controlled trial.