Long-Term Outcomes of Balloon Versus Surgical Aortic Valvuloplasty in Pediatric Patients with Congenital Aortic Valve Stenosis: A Meta-Analysis

Abstract

Background Congenital aortic valve stenosis (AVS) is the most common cause of ventricular outflow tract obstruction. Surgical aortic valvuloplasty (SAV) and balloon aortic valvuloplasty (BAV) are the most common primary interventions, with conflicting data regarding their long-term outcomes. We aimed to study the long-term clinical outcomes of patients allocated to BAV or SAV. Methods We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL through August 2025 for relevant studies reporting long-term outcomes of SAV versus BAV in patients with congenital AVS. The primary outcome was the 10-year rate of aortic valve replacement (AVR). Subgroup analysis was performed for all clinical outcomes according to the age of the included children. Results A total of nine trials including 1704 patients (67%, [1136/1704]) males; median follow-up of 10 years) were included. The pooled estimate showed that SAV was associated with lower long-term reintervention rates (risk ratio 0.76, 95% confidence interval (CI): 0.6 to 0.96, P = .02), and a significant reduction in peak aortic gradient pressure (PAGP) (mean difference (MD) −11.53 mm Hg, 95% CI: −18.66 to −4.41, P < .001) in patients more than 1 year of age. In addition, SAV was associated with a longer time to first reintervention in patients younger than 1 year of age (MD 2.43 years, 95% CI: 0.68 to 4.19, P = .01). There was no significant difference regarding the primary outcome or other studied outcomes. Conclusion In patients with congenital aortic valve stenosis, SAV showed the greatest benefit in children older than 1 year of age with similar AVR and mortality rates; but superior durability, lower reintervention rates, and greater reductions in peak aortic pressure gradient when compared with BAV.