646 A Ceasefire: Matched Analysis of Balloon vs Surgical Valvotomy for Congenital Aortic Stenosis

Abstract

Background: Balloon valvuloplasty and surgical aortic valvotomy have been the treatment mainstays for congenital aortic stenosis in children. Choice of intervention often differs depending upon center bias with limited relevant, comparative literature. Objectives: This study aims to provide an unbiased, contemporary matched comparison of these balloon and surgical approaches. Methods: Retrospective analysis of patients with congenital aortic valve stenosis who underwent balloon valvuloplasty (Queensland Children’s Hospital) or surgical valvotomy (Royal Children’s Hospital, Melbourne) between 2005 and 2016. Patients were excluded if pre-intervention assessment indicated ineligibility to either group. Propensity-score-matching was performed based on age, weight and valve morphology. Results: Sixty-five balloon patients and seventy-nine surgical patients were included. Overall the groups were well matched with 18 neonates / 25 infants in the balloon group and 17 neonates / 28 infants in the surgical group. Median age at balloon was 92 days (range 2 days - 18.8 years) compared to 167 days (range 0 days – 18.1 years) for surgery (Rank-sum p=0.08). Mean follow-up was 5.3 years. There was 1 late balloon death and 2 early surgical deaths due to left ventricular failure. There was no significant difference in freedom from re-intervention (FFI) at latest follow-up (69% in the balloon group and 70% in the surgical group, p=1.0). Conclusions: Contemporary analysis of balloon aortic valvuloplasty and surgical aortic valvotomy shows no difference in overall reintervention rates in the medium-term. Balloon valvuloplasty performs well across all age groups, achieving delay or avoidance of surgical intervention.L20085029152020-12-09 <br />