Long‐term outcomes up to 25 years following balloon pulmonary valvuloplasty: A multicenter study

Objective: Evaluate long‐term outcomes following balloon pulmonary valvuloplasty(BPV) for pulmonary stenosis (PS).
Background: Long‐term data following BPV is limited to small, single center studies.
Methods: BPV from April 12, 1985 to January 7, 2015 from three centers wereincluded. Outcomes studied were ≥ moderate PI by echocardiogram and residualPS ≥ 40 mm Hg. Risk factors for ≥ moderate PI, residual PS, and repeat interventionwere assessed by univariate and multivariate analysis.
Results: Among 254 patients, mean age at BPV was 3.8 years (range 1 day‐67years), initial PS catheter gradient was 56 mm Hg (IQR 40‐70), 19% had criticalPS, and 9% had genetic syndromes. Mean follow‐up duration was 7.5 years (maxi‐mum 25 years). Sixty‐nine (29%) had ≥ moderate PI, 41 patients (17%) had residualPS > 40 mm Hg, and 31 (13%) had re‐intervention. In univariate analysis, youngerage, lower weight, greater initial PS gradient, greater initial RV/systemic pressureratio, critical PS, and longer follow‐up duration were associated with ≥ moderatePI. Greater initial PS gradient was associated with long‐term residual PS or repeatintervention. In multivariate analysis, greater initial gradient and lower weight wereindependently associated with > moderate PI and greater initial PS gradient andgenetic abnormality were independently associated with residual PS and repeatintervention.
Conclusion: Smaller patients with greater initial PS were more likely to develop sig‐nificant long‐term PI. Patients with greater initial PS and genetic abnormalities weremore likely to have residual PS or require repeat intervention following BPV.