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Congenital aortic stenosis. Early and late results of aortic valvulotomy
Insights
Open aortic valvulotomy offers significant benefits for congenital aortic stenosis patients, especially those over one year old. While palliative, it provides long-term relief and low mortality, though reoperation is common.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Congenital aortic stenosis is a serious condition requiring timely intervention.
- Open aortic valvulotomy has been a surgical option for decades.
- Understanding long-term outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of open aortic valvulotomy for congenital aortic stenosis.
- To assess operative mortality, morbidity, and reoperation rates.
- To analyze survival and symptom-free status post-procedure.
Main Methods:
- Retrospective analysis of 87 patients undergoing open aortic valvulotomy between 1962 and 1979.
- Inclusion of patients with isolated stenosis and those with additional subvalvular abnormalities.
- Actuarial survival and reoperation-free survival analysis.
Main Results:
- Overall operative mortality was 3%, exclusively in infants under one year.
- Long-term survival showed 90% at 5 years and 87% at 10 years.
- Approximately 25% of patients required reoperation within 8 years; 61 patients remain symptom-free.
Conclusions:
- Open aortic valvulotomy provides significant immediate and long-term benefits for most congenital aortic stenosis patients.
- The procedure demonstrates low operative mortality and morbidity in patients over one year of age.
- Valvulotomy is a palliative treatment, necessitating reoperation in a notable proportion of cases over time.
Abstract:
Between 1962 and 1979, 87 patients with congenital aortic stenosis (11 infants from 4 days to 5 months, and 76 patients from one year to 24 years) underwent open aortic valvulotomy; in 14 patients an additional subvalvular membraneous ring or hypertrophic subaortic stenosis was resected. There were 3 early deaths (3%), all in infants less than one year of age. A second operation was necessary 3 months to 10 years (mean 6.3 +/- 4 years) after the initial procedure in 12 of the 84 survivors. In 9 patients an aortic valve replacement and in 3 patients a second valvulotomy was performed without perioperative mortality: in the latter group valve replacement had to be performed later. There were 5 late deaths (6%). The causes of death were endocarditis (2), thrombosis of the prosthesis (1), accident (1) and sudden death (1). The overall actuarial survival curve shows a 5-year survival of 90% and a 10-year survival of 87%; 87% are reoperation-free after 5 years and 75% after 8 years. At present 7 patients are scheduled for surgery because of recurrence of stenosis; 61 patients are symptom-free. It is concluded that aortic valvulotomy has immediate and long-term benefit in the large majority of patients. Operative mortality and morbidity are low in patients older than one year of age. Nevertheless aortic valvulotomy, which should not be performed too late, represents a palliative treatment and will lead to reoperation in approximately 25% of patients after 8 years.