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Surgery for critical aortic stenosis in newborns is still good therapy after 25 years
J S Vobecky1, C Chartrand, H Angaté
1Department of Cardiovascular Surgery, Sainte-Justine Hospital, Université de Montréal, Que.
Insights
Surgery for critical aortic stenosis in newborns has improved significantly. Recent advancements show a survival rate increase from 31% to 75%, making surgical intervention a viable option for this condition.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Neonatal Intensive Care
Background:
- Critical aortic stenosis presents a high operative mortality risk in newborn infants.
- Advancements in therapeutic modalities are crucial for improving outcomes.
Purpose of the Study:
- To review surgical outcomes for critical aortic stenosis in neonates.
- To identify risk factors and assess survival trends over time.
Main Methods:
- Retrospective review of 37 infants undergoing surgery for critical aortic stenosis between 1964 and 1990.
- Analysis of operative mortality, survival rates, and follow-up data.
- Comparison of outcomes between different surgical techniques (transventricular valvotomy vs. transaortic valvuloplasty).
Main Results:
- Overall survival improved from 31% to 75% in the latter 5 years of the study.
- Transventricular valvotomy was associated with 100% mortality.
- Risk factors for operative mortality included low surgical weight (<3000g) and prolonged cardiopulmonary bypass.
Conclusions:
- Surgical intervention for critical aortic stenosis in newborns has demonstrated significantly improved survival rates.
- Transaortic valvuloplasty is a preferred technique, while transventricular valvotomy is associated with high mortality.
- Early surgical management, considering patient weight and bypass duration, is essential for favorable outcomes.
Abstract:
Because of the high operative mortality in newborn infants with critical aortic stenosis, new therapeutic modalities have emerged. The authors reviewed their results of surgery for this condition in newborn infants between January 1964 and December 1990. Thirty-seven infants were operated on for critical aortic stenosis, which was diagnosed at a mean patient age of 14.5 days. The surgical procedure was done at a mean patient age of 37 days. Five infants died intraoperatively of ventricular fibrillation at the time of incision. Transventricular valvotomy was attempted in 4 infants, and the remaining 28 infants underwent transaortic valvuloplasty. Overall survival improved markedly in the last 5 years of the study, from 31% to 75%. All patients who had transventricular valvotomy died, as did the only infant with previous percutaneous aortic valvuloplasty. Of the infants who died, 38% weighed less than 3000 g at the time of operation compared with 13% of the survivors (p < 0.05). The duration of cardiopulmonary bypass was also identified as a risk factor (p = 0.001). Of the surviving infants, 93% were followed up at a mean of 66 months. All but one were in New York Heart functional class I or II. The following risk factors were identified for operative mortality: year of surgery, preoperative hemodynamic condition, associated anomalies of the left ventricle, surgical weight less than 3000 g, transventricular valvotomy, year of surgery and prolonged cardiopulmonary bypass. Because of the much improved survival recently, surgery remains a good therapeutic choice for critical aortic stenosis in the newborn infant.