Operative treatment of congenital aortic stenosis

The operative treatment of 131 patients with congenital aortic stenosis is reviewed. Of the 131 patients, 77% had left ventricular outflow tract (LVOT) obstruction at a single level and 23%, major obstruction at more than one level. There were 3 operative deaths (2.3%) and 10 late deaths (7.8%). Twenty of the 128 discharged patients have undergone a second procedure and 6 a third procedure for recurrent or residual LVOT obstruction. The 26 reoperations included 7 aortic valve replacements, 4 left ventricular apical-abdominal aortic (LV-AA) valved conduits, and 15 extensive aortic valvotomies with or without supravalvular aortoplasty. Five of the 20 patients undergoing reoperation died; 4 of these deaths occurred in patients who had valve replacement at reoperation. The 4 who received LV-AA conduits have sustained excellent hemodynamic and clinical results with no complications. Highly satisfactory clinical results can be obtained with minimal operative risk, regardless of the level of LVOT obstruction. Reoperation for recurrent or residual LVOT obstruction, however, is comparatively more hazardous, and alternative surgical approaches (LV-AA conduits) should be considered.