Introduction: Aortic valve stenosis accounts for around 3–6% of congenital heart disease, with an estimated incidence of 1–4 per 10,000 live births. In newborns and infants, it is a major cause of heart failure and it accounts for two-thirds of tthe lesions that cause obstruction of the left ventricular outflow tract. Balloon Aortic Valvuloplasty (BAV) is an effective treatment for congenital aortic stenosis associated with low rates of mortality and adverse events. It is a reasonably safe alternative to Surgical Aortic Valvotomy (SAV) and, although it does not provide a long-term solution, it may prolong the time before SAV or eventual valve replacement. BAV offers a shorter hospital stay, less discomfort and scarring, a lower cost, and the ability to be easily standardised and replicated. Data on the outcomes of BAV, however, are limited in developing countries. Hence in this study, we evaluated the practice, short (immediate) and mid-term (≥12 months) outcomes of BAV, as well as the factors associated with the complications.

Material and Method: This study involved single tertiary centre-based retrospective data with all the consecutive patients of severe congenital aortic stenosis who underwent balloon aortic valvuloplasty from 2017 to 2023. Data from the cardiac catheterization study, serial echocardiography reports, and in and out-patient hospital records were collected for the analysis. The short-term (immediate) and mid-term (≥12 months) outcomes of BAV were studied. The factors associated with the complications and freedom from re-intervention were also studied. The indications for percutaneous, transcatheter therapy for aortic stenosis were same as those used for surgical intervention.

Study Setting: Department of paediatric cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.

Duration: 2023 (September – November)

Study Population: All consecutive patients who presented with severe congenital aortic stenosis, who underwent balloon aortic valvuloplasty from 2017 to 2023.

Statistical Analysis: The collected data entered into Microsoft Excel spreadsheet. Statistical Package for the Social Science (SPSS) software and EXCEL-Version 16.73 were used for data analysis.

Results: During the study period, a total of eighty-three patients, newborns (n=9), infants (n=20) and children (n=54), underwent BAV. Left ventricular systolic dysfunction was present in 33 patients (19.7%) of the patients. Isolated AS was present in 70 patients (84.3%). Associated anomalies were present in 11 patients (15.7%): four (4.8%) had coarctation of the aorta, six (7.2%) had patent ductus arteriosus and one had ostium secundum ASD. 80 (96.4%) had bicuspid aortic morphology with predominant R+L fusion 63 (78.8%). BAV was not associated with perioperative or immediate postoperative mortality. Immediately following the valvuloplasty, a more than mild aortic regurgitation was noted only in two patients (20.5%). A none-to-mild aortic regurgitation was noted in the remaining 79.5%. Four patients (4.8%) required early surgical aortic valve repair immediately after the procedure because of severe aortic regurgitation. At a mean follow-up of 12 months, eighteen patients (23.3%) had more than mild aortic regurgitation, and five patients (7%) required surgical intervention. Kaplan–Meier freedom from aortic valve reintervention was 97% at 1 year and 83% at 76 months of follow-up.

Conclusion: Based on outcomes encountered at a tertiary center, BAV is an effective and safe modality associated with low complication rates.