Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Rapid right ventricular pacing for balloon valvuloplasty in congenital aortic stenosis: A systematic review
Konstantinos S Mylonas, Ioannis A Ziogas, Charitini S Mylona, Dimitrios V Avgerinos, Christos Bakoyiannis, Fotios Mitropoulos, Aphrodite Tzifa
Konstantinos S Mylonas, Department of Cardiothoracic Surgery, Yale New Haven Hospital, New Haven, CT 06510, United States
Ioannis A Ziogas, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
Charitini S Mylona, Department of Pediatrics, Trikala General Hospital, Trikala 42100, Greece
Dimitrios V Avgerinos, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, New York, NY 10065, United States
Christos Bakoyiannis, Division of Vascular Surgery, First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
Fotios Mitropoulos, Department of Pediatric Cardiac Surgery, Mitera Children’s Hospital, Athens 15123, Greece
Aphrodite Tzifa, Department of Pediatric Cardiology and Adult Congenital Heart Disease, Mitera Children’s Hospital, Athens 15123, Greece
Author contributions: Mylonas KS did conception/design of the study, acquisition, analysis and interpretation of data, manuscript drafting, critical revision, final approval; Ziogas IA did acquisition, analysis and interpretation of data, manuscript drafting, critical revision, final approval; Mylona C did acquisition of data, critical revision, final approval; Avgerinos DV, Bakoyiannis C, Mitropoulos F and Tzifa A did conception/design of the study, critical revision, final approval.
Conflict-of-interest statement: The authors have no conflict of interest and no financial ties to declare.
PRISMA 2009 Checklist statement: We conducted the present systematic review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Konstantinos S Mylonas, MD, Doctor, Department of Cardiothoracic Surgery, Yale New Haven Hospital, 20, York Street, New Haven, CT 06510, United States. konstantinos.mylonas@yale.edu
Received: August 25, 2020
Peer-review started: August 25, 2020
First decision: September 21, 2020
Revised: September 22, 2020
Accepted: October 11, 2020
Article in press: October 11, 2020
Published online: November 26, 2020
BACKGROUND
Balloon aortic valvuloplasty (BAV) is a well-established treatment modality for congenital aortic valve stenosis.
AIM
To evaluate the role of rapid right ventricular pacing (RRVP) in balloon stabilization during BAV on aortic regurgitation (AR) in pediatric patients.
METHODS
A systematic review of the MEDLINE, Cochrane Library, and Scopus databases was conducted according to the PRISMA guidelines (end-of-search date: July 8, 2020). The National Heart, Lung, and Blood Institute and Newcastle-Ottawa scales was utilized for quality assessment.
RESULTS
Five studies reporting on 72 patients were included. The studies investigated the use of RRVP-assisted BAV in infants (> 1 mo) and older children, but not in neonates. Ten (13.9%) patients had a history of some type of aortic valve surgical or catheterization procedure. Before BAV, 58 (84.0%), 7 (10.1%), 4 (5.9%) patients had AR grade 0 (none), 1 (trivial), 2 (mild), respectively. After BAV, 34 (49.3%), 6 (8.7%), 26 (37.7%), 3 (4.3%), patients had AR grade 0, 1, 2, and 3 (moderate), respectively. No patient developed severe AR after RRVP. One (1.4%) developed ventricular fibrillation and was defibrillated successfully. No additional arrhythmias or complications occurred during RRVP.
CONCLUSION
RRVP can be safely used to achieve balloon stability during pediatric BAV, which could potentially decrease AR rates.
Core Tip: Balloon aortic valvuloplasty (BAV) for congenital aortic valve stenosis is well established. Rapid right ventricular pacing (RRVP) is helpful in achieving balloon stability in children undergoing aortic valve dilatation. Our findings demonstrate that RRVP is an effective and safe procedure that helps stabilize the balloon during BAV and decreases the rate of aortic regurgitation in the pediatric population. No reports of severe aortic regurgitation after RRVP-assisted BAV have been published to date.
