The results of open heart surgery and percutaneous balloon valvuloplasty in infants with congenital aortic valve stenosis
Objective. To analyze the long-term results of surgical treatment of congenital aortic stenosis in infants. Material and methods. Between 2011 and 2018, 84 surgical procedures for congenital aortic stenosis in patients under 1 year were performed at Federal Center for Cardiovascular Surgery of the Ministry of Healthcare of Russian Federation. There were 2 groups depending on the type of primary intervention. The first group included patients who underwent “open heart” surgery ( n =46), the second group - patients after performing transluminal balloon valvuloplasty ( n =38). The median age at the time of surgery was 53 days (varying from 1 to 327). Results. Early postoperative mortality was 3 (3,5%) patients independent of the group. There were no late postoperative mortality. Redo open heart surgery was performed in 8 (9.5%) patients. The actuarial freedom from reoperations in terms of follow up to 7 years for patients of the 1st group was at 86,2% and for patients of second group was 57,8% ( p =0.04). The statistically significant influence of the following risk factors on the probability of aortic valve restenosis in the long-term period was revealed: balloon valvuloplasty (odds ratio (OR) 1.87; confidence inteval (CI) 1.11-3.21; p =0.04), the significant systolic pressure gradient on the aortic valve at the time of discharge (OR 1.1; CI 1.02-1.41; p =0.01). Conclusions. According to the results of this study surgical valvuloplasty with bypass and balloon valvuloplasty are both effective methods for the treatment of aortic stenosis in infants. Endovascular balloon valvuloplasty in children group of under the group age of one year may be used as a destination therapy or as a first stage correction of the defect. High mean peak pressure gradient in the postoperative period increase the risk of reoperations