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[Aortic valve stenosis in children. Surgical valvuloplasty long-term results]
C Chartrand1, E Saro-Servando, J S Vobecky
1Service de Chirurgie Cardio-Vasculaire, Hôpital Sainte-Justine, Montréal, Québec, Canada.
Insights
Surgical aortic valvuloplasty effectively manages congenital aortic stenosis in children, offering excellent long-term control and survival rates into adulthood. This procedure demonstrates sustained benefits for over 20 years in most pediatric patients.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Context:
- Congenital aortic stenosis poses significant risks to children.
- Aortic valvuloplasty is a critical intervention for this condition.
- Long-term outcomes of pediatric aortic valvuloplasty require extensive evaluation.
Purpose:
- To assess the long-term efficacy and safety of aortic valvuloplasty in pediatric patients with congenital aortic stenosis.
- To evaluate survival rates, reoperation rates, and the need for aortic valve replacement following initial valvuloplasty.
- To analyze outcomes of repeat valvuloplasty and other surgical revisions.
Summary:
- A 20-year follow-up of 67 children undergoing aortic valvuloplasty for congenital aortic stenosis showed no hospital mortality.
- Late mortality was low, with 11.9% developing aortic regurgitation and 15% requiring reoperation due to restenosis.
- Repeat valvuloplasty yielded excellent results in some cases, while others required aortic valve replacement; overall 20-year survival was 94%.
Impact:
- Surgical valvuloplasty provides safe and effective long-term control of congenital aortic stenosis in children.
- The beneficial effects of the procedure are maintained for over two decades in the majority of patients.
- This study supports aortic valvuloplasty as a durable treatment option for pediatric congenital aortic stenosis.
Abstract:
From 1960 through 1992, 67 children with congenital aortic stenosis aged 6-228 months (M 105.7 +/- 52) were submitted to aortic valvuloplasty at our institution. There was no hospital mortality. During the follow-up of 127.5 +/- 66.7 months, there were two late valve related deaths. Eight patients (11.9%) developed aortic regurgitation 5 to 125 months (M 66.6 +/- 35) following surgical valvuloplasty and one of them required aortic valve replacement. Because of restenosis, 15 patients required a second operation. Of them five children underwent a second aortic valvuloplasty without mortality and, in four of them, the functional result has been excellent after a mean follow-up of 75.4 +/- 12 months. Ten patients required an aortic valve replacement 62 to 208 months post-op (M 100.9 +/- 50.8). Mechanical prosthesis were used in 6 and bioprosthesis in 4. Two patients required a Konno and one patient a Ross procedure. There were no early nor late deaths following reoperations. The 20 year survival rate following the first valvuloplasty was 94%, the freedom from reoperation 63% and the freedom from aortic valve replacement 73% for the same time period. Our results demonstrate that congenital aortic valvar stenosis in children can be surgically well controlled until adulthood. Our study also illustrates that surgical valvuloplasty is a safe and efficacious procedure and that its beneficial effect is maintained over 20 years in the majority of children.