Vol.:(0123456789) 1 3 Pediatric Cardiology https://doi.org/10.1007/s00246-018-1929-1 ORIGINAL ARTICLE Comparison of Balloon Dilatation and Surgical Valvuloplasty in Non- critical Congenital Aortic Valvular Stenosis at Long-Term Follow-Up Sezen Ugan Atik 1  · Ayşe Güler Eroğlu 1  · Betül Çinar 2  · Murat Tuğberk Bakar 3  · İrfan Levent Saltik 1 Received: 17 March 2018 / Accepted: 6 June 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract The two main modalities used for congenital aortic valvular stenosis (AVS) treatment are balloon aortic valve dilatation (BAD) and surgical aortic valvuloplasty (SAV). This study evaluates residual and recurrent stenosis, aortic regurgitation (AR) development/progression, reintervention rates, and the risk factors associated with this end point in patients with non- critical congenital AVS who underwent BAD or SAV after up to 18 years of follow-up. From 1990 to 2017, 70 consecutive interventions were performed in patients with AVS, and 61 were included in this study (33 BADs and 28 SAVs). There were no signifcant diferences in age, sex distribution, PSIG, and AR frequency between the BAD and SAV groups. Bicuspid valve morphology was more common in the BAD group than the SAV group. There was no statistically signifcant diference between PSIGs and AR development or progression after intervention at the immediate postoperative echocardiography of patients who underwent BAD or SAV (p = 0.82 vs. p = 0.29). Patients were followed 6.9 ± 5.1 years after intervention. The follow-up period in the SAV group was longer than that of the BAD group (9.5 ± 5.4 vs. 5.5 ± 4.4 years, p = 0.003). There was no statistically signifcant diference in the last echocardiographic PSIG between patients who underwent SAV or BAD (51.1 ± 33.5 vs. 57.3 ± 35.1, p = 0.659). Freedom from reintervention was 81.3% at 5 years and 57.5% at 10 years in the BAD group and 95.5% at 5 years and 81.8% at 10 years in the SAV group, respectively (p = 0.044). There was no diference in postprocedural immediate PSIG and last PSIG at follow-up and the development/progression of AR between patients who were treated with BAD versus SAV. However, long-term results of SAV were superior to those of BAD, with a somewhat prolonged reintervention interval. Keywords Aortic valvular stenosis · Balloon aortic valve dilatation · Echocardiography · Surgical aortic valvuloplasty Introduction Aortic valvular stenosis (AVS) accounts for approximately 7.7% of all congenital heart diseases [1]. The two main treat- ment modalities used for AVS in the pediatric population are surgical aortic valvuloplasty (SAV) and balloon aortic valve dilatation (BAD) [2, 3]. Surgical valvuloplasty, introduced by Lillehei in 1956, was the only therapeutic option until 1983, when Lababidi introduced BAD [2, 3]. In the current era, both treatment modalities are available with preference dependent on the institution [4–8]. However, there are a limited number of long-term follow-up studies that allow appropriate comparison of BAD and SAV in patients with congenital AVS [9–11]. Consequently, there is still no con- sensus regarding the most efcacious initial treatment. This study evaluates residual and recurrent stenosis, aor- tic regurgitation (AR) development and progression, reinter- vention rates, and risk factors associated with this end point in patients with non-critical congenital AVS who underwent BAD or SAV during long-term follow-up. Materials and Methods Since 1990, 388 patients with non-critical congenital AVS were evaluated by echocardiography at our institu- tion. Patients with incomplete medical records, abnormal * Sezen Ugan Atik sezenugan@hotmail.com 1 Department of Pediatric Cardiology, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey 2 Department of Pediatrics, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey 3 Department of Public Health, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey