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Incidence of Reoperation After Surgical Procedure for Left Ventricular Outflow Tract Obstruction in Children and
Benish Fatima1, Hartzell V Schaff1, Elizabeth H Stephens1
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Insights
Patients with subaortic stenosis (SAS) had better long-term survival than those with hypertrophic cardiomyopathy (HCM) after surgery for left ventricular outflow tract obstruction (LVOTO). Despite needing more reoperations, SAS patients experienced superior outcomes.
Area of Science:
- Cardiology
- Pediatric Surgery
- Congenital Heart Disease
Background:
- Subaortic left ventricular outflow tract obstruction (LVOTO) is commonly caused by hypertrophic cardiomyopathy (HCM) and subaortic stenosis (SAS).
- Reoperation for LVOTO may be necessary due to disease recurrence, congenital defects, or surgical complications.
- Comparing long-term outcomes in young patients with HCM versus SAS is crucial for surgical management.
Purpose of the Study:
- To compare the late clinical outcomes, including survival and reoperation rates, of pediatric patients who underwent surgery for LVOTO caused by HCM versus SAS.
- To identify differences in preoperative symptoms and surgical outcomes between the two groups.
Main Methods:
- A retrospective study analyzed clinical, echocardiographic, and operative data of patients ≤21 years old undergoing LVOTO surgery between 1963 and 2018.
- Patients were stratified into HCM (n=152) and congenital SAS (n=63) groups.
- Survival and cumulative incidence of reoperation were compared between the groups.
Main Results:
- Patients with HCM were older and more symptomatic preoperatively than those with SAS.
- Thirty-day mortality was low in both groups (1.3% for HCM, 0% for SAS).
- While survival was similar in the first decade post-surgery, HCM patients had poorer survival in the second decade (20-year survival: 80% for HCM vs. 91% for SAS; P=.007).
- Reoperation for recurrent LVOTO within 10 years was significantly higher in the SAS group (31%) compared to the HCM group (5%; P<.001).
Conclusions:
- Patients with HCM present with more symptoms preoperatively compared to those with SAS.
- Despite a higher need for reoperation, patients with SAS demonstrated superior late survival compared to patients with HCM after surgical correction of LVOTO.
Background:
The common causes of subaortic left ventricular outflow tract obstruction (LVOTO) are hypertrophic cardiomyopathy (HCM) and membranous/tunnel subaortic stenosis (SAS). Reoperation after corrective surgery may be due to recurrent disease, associated congenital defects, or complications of the initial procedure. This study compares the late outcomes of young patients with HCM and SAS.
Methods:
We studied clinical, echocardiographic, and operative data of patients ≤21 years of age at the time of surgery for LVOTO between August 1963 and August 2018. We stratified patients into HCM (n = 152) and congenital SAS (n = 63) groups and compared survival and cumulative incidence of reoperation.
Results:
At initial repair, patients with HCM were older than patients with SAS (median [interquartile range] age, 15 [10-19] years vs 8 [5-13] years; P < .001), and patients with HCM were more symptomatic with dyspnea (P < .001), chest pain (P = .002), and presyncope/syncope (P = .005). Thirty-day mortality was 1.3% vs 0% for HCM and SAS groups. During a median follow-up of 13.1 years, survival was similar through the first 10 years; but during the second decade, patients with HCM had poorer survival (survival at 20 years, 80% vs 91% for patients with SAS; P = .007). Ten years after repair, reoperation for recurrent LVOTO was performed in 5% of patients with HCM vs 31% in those with SAS (P < .001).
Conclusions:
In this surgical cohort, patients with HCM were more symptomatic preoperatively than those with SAS. Late survival of patients with SAS was superior to that of patients with HCM despite a greater need for reoperation.
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