Individualised surgical treatment strategy for subaortic stenosis

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Subaortic stenosis is a significant cause of left ventricular outflow tract obstruction.
• Surgical intervention is the primary treatment for symptomatic subaortic stenosis.
• Optimal surgical strategies require consideration of anatomical variations and associated pathologies.

Purpose of the Study:

• To review clinical data of patients with subaortic stenosis treated surgically over 12 years.
• To analyze short-term and long-term clinical outcomes.
• To compare different surgical methods for subaortic stenosis to determine the optimal treatment strategy.

Main Methods:

• Retrospective review of 90 patients with subaortic stenosis from December 2010 to December 2022.
• Patients divided into two groups: simple subaortic membrane resection (Group A) and extended resection/modified Konno procedure (Group B).
• Comparison of pre-operative and post-operative pressure gradients, survival rates, and aortic regurgitation management.

Main Results:

• Overall early mortality was 3.33%; one late death in Group B.
• No significant difference in long-term survival rates between groups (p=0.904).
• Group B had higher pre-operative gradients but similar post-operative gradients to Group A. Simultaneous aortic valvuloplasty in Group B improved aortic regurgitation (p=0.013).

Conclusions:

• Individualized surgical treatment for subaortic stenosis achieves good long-term outcomes.
• Long-term survival and freedom from reoperation are comparable between simple membrane resection and extended resection.
• Simultaneous aortic valvuloplasty is beneficial for patients with moderate or greater aortic regurgitation undergoing extended resection.