Balloon Aortic Valvuloplasty in the First Year of Life: Hemodynamic Outcomes, Risk Factors for Reintervention and the Protective Role of Rapid Pacing
LJE Stoelinga1, MMC Molenschot1, GJ Krings1, JMPJ Breur1*
1Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center of Utrecht, Utrecht, The Netherlands.
*Corresponding Author: JMPJ Breur, Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center of Utrecht, Utrecht, The Netherlands.
https://doi.org/10.58624/SVOAPD.2026.05.004
Received: March 13, 2026
Published: April 02, 2026
Citation: Stoelinga LJE, Molenschot MMC, Krings GJ, Breur JMPJ. Balloon Aortic Valvuloplasty in the First Year of Life: Hemodynamic Outcomes, Risk Factors for Reintervention and the Protective Role of Rapid Pacing. SVOA Paediatrics 2026, 5:2, 20-41. doi: 10.58624/SVOAPD.2026.05.004
Abstract
Background: Congenital valvular aortic stenosis is a progressive lesion that can lead to critical heart failure in neonates and infants. While balloon aortic valvuloplasty (BAV) is the preferred primary intervention, long term success is often limited by restenosis and progressive aortic regurgitation (AR). This study aims to evaluate the time to reintervention and identify risk factors associated with early reintervention in children treated within the first year of life.
Methods: We conducted a retrospective, single-center study (2002-2024) including 63 patients (aged 0-1 year) who underwent primary BAV. Patients were categorized into neonates (0-28 days, n=26) and infants (29-365 days, n=37). Hemodynamic and echocardiographic parameters were analyzed pre-procedure, post procedure, and at the latest follow-up. The primary endpoint was time to first surgical or catheter-based reintervention.
Results: BAV achieved a significant reduction in echocardiographic peak gradient (from a median of 76.1 mmHg to 34.3 mmHg; p < 0.0001). Overall freedom from reintervention was 58.7% at 1 year and 44.9% at 10 years, followed by a stable plateau. Multivariable Cox proportional hazard regression analysis identified neonatal age as a significant independent risk factor for reintervention [HR 2.39; 95% CI: 1.00-5.70; p = 0.049], while the use of rapid pacing was a significant protective factor [HR 0.43; 95% CI: 0.19-0.95; p = 0.037]. Notably, the use of rapid pacing did not significantly increase AR severity in this population. At the latest follow-up, moderate-to-severe AR was present in 39.9% of the total cohort, and progressive left ventricular dilation was observed, particularly in neonates (median LVEDD z-score 2.1).
Conclusion: Balloon aortic valvuloplasty is an effective initial treatment for congenital valvular aortic stenosis in patients 0-1 years of age, providing substantial acute relief of obstruction and almost 50% freedom from reinterventions after 10 years. While neonates face a twofold higher risk for reintervention, rapid pacing significantly reduces the risk for reinterventions in our population.
Keywords: Congenital heart disease; Congenital aortic stenosis; Balloon aortic valvuloplasty; Durability; Rapid pacing.