Rączka Marek, Kuźma Jacek, Król Wanda, Weryński Piotr, Rudziński Andrzej, Skalski Janusz Hieronim, Góreczny Sebastian
Department of Pediatric Cardiology, Jagiellonian University, Medical College, Krakow, Poland.
Cardiothoracic and Transplantology Department, Medical University of Warsaw, Warsaw, Poland.
Kardiochir Torakochirurgia Pol. 2025 Mar;22(1):20-25. doi: 10.5114/kitp.2025.148561. Epub 2025 Mar 17.
Newborns with critical aortic valve stenosis (AVS) constitute a challenging group of patients, requiring urgent treatment, which in most centers is currently transcatheter balloon aortic valvuloplasty (BAV).
Assessment the immediate and long-term outcome of BAV in newborns including preterm infants with critical AVS.
We analyzed retrospectively 28 neonates (including 7 preterm infants) with critical AVS treated with the BAV procedure at mean age of 12.1 days. The mean follow-up period was 6.4 years. Patients were divided into 2 groups depending on the left ventricle ejection fraction (LVEF) ≤ 40% - group I ( = 12 patients, including 5 preterm infants) and > 40% - group II ( = 16 patients, including 2 prematures).
In both groups, the peak transvalvular pressure gradient across the aortic valve (TAPG) decreased significantly after BAV, whereas the mean LVEF increased significantly only in group I newborns. Various adverse events occurred in 6 (21.4%) newborns. A total of 12 (42.8%) children required re-intervention, including 1 child who underwent 3 procedures. They occurred slightly more often in children born prematurely (57.1%) compared to children born at term (38%). During follow-up, 6 patients died, 5 patients in group I and 1 in group II, including 3 of 7 preterm infants (all in group I). The Kaplan-Meier survival curve showed significantly higher mortality in group I patients ( = 0.03).
BAV as the initial treatment for newborns with critical AVS gives satisfactory results, but further follow-up shows a frequent need for re-intervention. Significant LV systolic dysfunction and prematurity are risk factors for higher mortality in these patients.
患有严重主动脉瓣狭窄（AVS）的新生儿是一组具有挑战性的患者，需要紧急治疗，目前在大多数中心，这种治疗是经导管球囊主动脉瓣成形术（BAV）。
评估BAV治疗包括患有严重AVS的早产儿在内的新生儿的近期和长期结果。
我们回顾性分析了28例接受BAV手术治疗的严重AVS新生儿（包括7例早产儿），平均年龄为12.1天。平均随访期为6.4年。根据左心室射血分数（LVEF）将患者分为两组，LVEF≤40%为I组（n = 12例患者，包括5例早产儿），LVEF>40%为II组（n = 16例患者，包括2例早产儿）。
两组中，BAV术后主动脉瓣跨瓣压差峰值（TAPG）均显著降低，而仅I组新生儿的平均LVEF显著升高。6例（21.4%）新生儿发生了各种不良事件。共有12例（42.8%）儿童需要再次干预，其中1例儿童接受了3次手术。与足月儿（38%）相比，早产儿（57.1%）发生再次干预的频率略高。随访期间，6例患者死亡，I组5例，II组1例，包括7例早产儿中的3例（均在I组）。Kaplan-Meier生存曲线显示I组患者的死亡率显著更高（P = 0.03）。
BAV作为患有严重AVS新生儿的初始治疗方法可取得满意结果，但进一步随访显示经常需要再次干预。显著的左心室收缩功能障碍和早产是这些患者死亡率较高的危险因素。
