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

doi:10.4330/wjc.v12.i11.540

Rapid right ventricular pacing for balloon valvuloplasty in congenital aortic stenosis: A systematic review

World J Cardiol. 2020 Nov 26;12(11):540-549. doi: 10.4330/wjc.v12.i11.540.

Authors

Konstantinos S Mylonas¹, Ioannis A Ziogas², Charitini S Mylona³, Dimitrios V Avgerinos⁴, Christos Bakoyiannis⁵, Fotios Mitropoulos⁶, Aphrodite Tzifa⁷

Affiliations

¹ Department of Cardiothoracic Surgery, Yale New Haven Hospital, New Haven, CT 06510, United States. konstantinos.mylonas@yale.edu.
² Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
³ Department of Pediatrics, Trikala General Hospital, Trikala 42100, Greece.
⁴ Department of Cardiothoracic Surgery, New York Presbyterian Hospital, New York, NY 10065, United States.
⁵ Division of Vascular Surgery, First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece.
⁶ Department of Pediatric Cardiac Surgery, Mitera Children's Hospital, Athens 15123, Greece.
⁷ Department of Pediatric Cardiology and Adult Congenital Heart Disease, Mitera Children's Hospital, Athens 15123, Greece.

Abstract

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.

Keywords: Aortic regurgitation; Balloon aortic valvuloplasty; Congenital aortic stenosis; Congenital heart disease; Rapid right ventricular pacing; Systematic review.