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Treatment of valvular aortic stenosis in children: a 20-year experience in a single institution
Cecilia Kjellberg Olofsson1,2, Håkan Berggren1, Björn Söderberg1
1Department of Cardiology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden.
Insights
Surgical valvotomy for pediatric aortic stenosis shows low mortality but frequent reinterventions. This long-term study supports surgical treatment as the preferred initial approach for isolated valvular aortic stenosis in children.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Isolated valvular aortic stenosis is a significant congenital heart defect in children.
- Surgical valvotomy is often the preferred initial treatment.
- Long-term outcomes and reintervention rates require thorough evaluation.
Purpose of the Study:
- To assess the short- and long-term outcomes of surgical valvotomy for isolated valvular aortic stenosis in pediatric patients.
- To evaluate mortality, reintervention rates, and the need for aortic valve replacement.
- To determine if current treatment policies should be revised based on long-term follow-up data.
Main Methods:
- Retrospective review of 113 pediatric patients (0-18 years) treated between 1994 and 2013.
- Analysis of initial treatment mode, mortality, reinterventions, and aortic valve replacement.
- Mean follow-up of 11 years (range 2-22 years).
Main Results:
- No early deaths and only 2 late deaths reported in 113 patients.
- 92 patients underwent open surgical valvotomy as the primary intervention.
- Freedom from reintervention was 56% at 20 years; 45% of those aged 18+ required aortic valve replacement by follow-up.
Conclusions:
- Surgical valvotomy for pediatric aortic stenosis is associated with excellent survival rates.
- Reinterventions are common, with a significant need for aortic valve replacement later in life.
- Current policy of surgical valvotomy as the first intervention for isolated valvular aortic stenosis is supported by these findings.
Objectives:
This study presents short- and long-term follow-up after treatment for isolated valvular aortic stenosis in children with surgical valvotomy as the preferred 1st intervention.
Methods:
All patients aged 0-18 years treated between 1994 and 2013 at our centre were reviewed regarding the mode of first treatment, mortality, reinterventions and the need for aortic valve replacement.
Results:
A total of 113 patients were identified in local registries. There were 44 neonates, 31 infants and 38 children. The mean follow-up period was 11 years (range 2-22 years). No early deaths and only 2 late deaths were reported. Of the 113 patients, 92 patients had open surgical valvotomy as the 1st intervention. Freedom from reintervention was 80%, 69%, 61%, 57% and 56% at 1, 5, 10, 15 and 20 years, respectively. The main indication for reintervention was valvular stenosis. Freedom from aortic valve replacement was 67%.
Conclusions:
Surgical valvotomy of aortic stenosis in this long-term follow-up study resulted in no 30-day mortality and <1% late mortality. Reinterventions were common, with 38% of the patients having further surgery or catheter treatment of the aortic valve before the age of 18 years. Among the 40 patients aged 18 years or older at follow-up, 45% had had the aortic valve replaced. Our data do not allow comparison of catheter and surgical treatment, but, based on these results, we find no reason to change our current policy of surgical treatment as 1st intervention in patients with isolated valvular aortic stenosis.
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