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Reoperation in congenital aortic stenosis
Insights
Critical aortic stenosis in children requires ongoing management. Repeat operations improve long-term survival, especially for subvalvular lesions, emphasizing the need for vigilant follow-up and intervention.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Congenital Heart Disease
Background:
- Critical aortic stenosis presents a significant challenge in pediatric cardiac care.
- Management strategies evolve over time, impacting long-term outcomes.
Purpose of the Study:
- To evaluate the long-term outcomes and survival rates of pediatric patients undergoing surgical repair for critical aortic stenosis.
- To assess the impact of reoperations on survival and functional status.
Main Methods:
- Retrospective analysis of 81 pediatric patients (3 days to 20 years) undergoing initial aortic stenosis surgery over 22 years.
- Long-term follow-up of survivors, including those requiring one or more reoperations.
- Actuarial survival analysis and comparison of outcomes based on stenosis type (valvular vs. subvalvular).
Main Results:
- Perioperative mortality was 3.7% for initial operations and 18.2% for reoperations.
- Actuarial reoperation-free survival was 56.7% at 10 years; overall survival was 88.6% at 10 years.
- Patients with valvular stenosis had significantly poorer survival compared to those with subvalvular lesions (p = 0.03).
Conclusions:
- Children with critical aortic stenosis benefit from continuous monitoring, including recatheterization and timely reoperations.
- Aggressive management with reoperation is crucial for optimizing long-term survival and functional outcomes in this population.
- Distinguishing between valvular and subvalvular stenosis is important for prognostic assessment.
Abstract:
Over a 22-year period, 81 patients underwent initial operations for critical aortic stenosis at our institution. Their ages ranged from 3 days to 20 years (mean, 7.3 +/- 5.9 years). Fourteen (17%) were infants less than 1 year old. Three children died perioperatively (3.7%). We have followed the survivors and 3 children who underwent initial operations elsewhere for a mean of 9.0 +/- 6.8 years (range, 2 to 23 years). To the present, 27 patients have undergone one reoperation (24 of our initial survivors) at a mean interval of 7.3 years, with 2 perioperative deaths. Ten of these patients have required a second reoperation at a mean interval of 3.7 years, with 2 deaths perioperatively. There were 3 late cardiac deaths after the initial procedure and 1 after a third operation. Actuarial reoperation-free survival is 56.7% at 10 years. While overall survival is 88.6% at 10 years, we find a significantly poorer survival among those patients with valvular stenosis compared with those with subvalvular lesions (p = 0.03). We believe that for children with all levels of aortic stenosis, good functional results and survival can best be obtained by follow-up, recatheterization, and reoperation.