Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2020; 12(11): 540-549
Published online Nov 26, 2020. doi: 10.4330/wjc.v12.i11.540
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
ARTICLE HIGHLIGHTS
Research background

Congenital aortic valve stenosis is the most frequent type of left ventricular outflow tract obstruction in the pediatric population and accounts for more than three-fourths of the left ventricular outflow tract obstruction cases in children. The two most commonly implemented modalities include balloon aortic valvuloplasty (BAV) and surgical aortic valvotomy, which have demonstrated an equivalent incidence of aortic regurgitation (AR), gradient reduction, and survival outcomes.

Research motivation

Another mode of balloon stabilization during BAV includes rapid ventricular pacing, which decreases stroke volume, pulse pressure, and blood pressure without causing cardiac standstill and without the limitations associated with other techniques. Rapid right ventricular pacing (RRVP) was initially reported in 2002 and has since been broadly implemented throughout the world. Rapid left ventricular pacing has also been reported but is less widely implemented. RRVP is commonly utilized during BAV in older children and adults, but there is a scarcity of data regarding neonates and infants.

Research objectives

RRVP is commonly utilized during BAV in older children and adults, but there is a scarcity of data regarding neonates and infants. We aimed to systematically review the literature and assess the safety and efficacy of RRVP-assisted BAV in children.

Research 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.

Research 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 aortic regurgitation (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.

Research conclusions

RRVP is an effective and safe procedure that can help stabilize the balloon during BAV and decrease subsequent AR rates. No reports of severe AR after RRVP-assisted BAV in children have been published to date.

Research perspectives

Future studies should explore the role of RRVP-assisted BAV in neonates and infants.