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Meta-Analysis
. 2016 Aug 8;5(8):e003931.
doi: 10.1161/JAHA.116.003931.

Surgical Valvotomy Versus Balloon Valvuloplasty for Congenital Aortic Valve Stenosis: A Systematic Review and Meta-Analysis

Garick D Hill  1 , Salil Ginde  2 , Rodrigo Rios  2 , Peter C Frommelt  2 , Kevin D Hill  3
Affiliations
Meta-Analysis

Surgical Valvotomy Versus Balloon Valvuloplasty for Congenital Aortic Valve Stenosis: A Systematic Review and Meta-Analysis

Garick D Hill et al. J Am Heart Assoc. .

Abstract

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.

Keywords: aortic surgery; aortic valve stenosis; balloon aortic valvuloplasty; congenital heart defects; meta‐analysis.

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Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Forest plot comparing incidence of moderate or greater aortic valve regurgitation prior to discharge or at early postoperative follow‐up (A) and hospital or 30‐day mortality (B) by intervention. The Brown study was excluded from mortality plot because there were no deaths in either group. Noncomparative studies of SAV and BAV were combined as “All others.” BAV indicates balloon aortic valvuloplasty; SAV surgical aortic valvotomy.
Figure 3
Figure 3
Kaplan‐Meier curves for survival (A), freedom from aortic valve replacement (B), and freedom from reintervention (C) by intervention in all patients <18 years of age. BAV indicates balloon aortic valvuloplasty; SAV surgical aortic valvotomy.
Figure 4
Figure 4
Kaplan‐Meier curves for survival (A), freedom from aortic valve replacement (B), and freedom from reintervention (C) by intervention in infants <1 year of age at initial intervention. BAV indicates balloon aortic valvuloplasty; SAV, surgical aortic valvotomy.
See this image and copyright information in PMC

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