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Discrete subaortic stenosis. Operative age and gradient as predictors of late aortic valve incompetence
G Rizzoli1, E Tiso, A Mazzucco
1Istituto di Chirurgia Cardiovascolare, dell'Università di Padova, Italy.
Insights
Early surgical repair of discrete subaortic stenosis is recommended. Factors like older age, higher preoperative gradient, cardiomegaly, and myectomy influence aortic valve incompetence post-surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pediatric Cardiology
Background:
- Discrete subaortic stenosis (DSS) is a congenital heart defect.
- Aortic valve incompetence can be a complication of DSS.
- Surgical intervention is the primary treatment for symptomatic DSS.
Purpose of the Study:
- To analyze the long-term outcomes of surgical repair for discrete subaortic stenosis.
- To identify predictors of aortic valve incompetence following DSS repair.
- To support evidence-based clinical decision-making for DSS management.
Main Methods:
- Retrospective analysis of 67 patients who underwent surgical repair for DSS between 1969 and 1990.
- Exclusion of patients with intrinsic lesions, prosthetic replacement, or extensive aortic valve remodeling.
- Multivariate ordinal logistic regression to identify predictors of aortic valve incompetence at follow-up.
Main Results:
- Aortic valve incompetence developed or persisted in a significant portion of patients.
- Older age at operation, higher preoperative gradient, preoperative cardiomegaly, and surgical myectomy were significant predictors of aortic incompetence.
- An interaction between age and gradient was observed, influencing outcomes.
Conclusions:
- The study supports a policy of early surgical repair for discrete subaortic stenosis.
- Predictive factors for aortic valve incompetence can aid in surgical planning and patient selection.
- Development of nomograms can assist in clinical decision-making for DSS management.
Abstract:
Between January 1969 and May 1990, 100 patients were operated on for discrete subaortic stenosis. Three patients died in the perioperative period. Patients with intrinsic lesions, prosthetic replacement, or extensive operative remodeling of the aortic valve were excluded from the analysis. The 67 remaining patients had a median follow-up of 62 months. Preoperatively, 8 patients had aortic valve competence, 51 had mild incompetence, and 8 patients moderate aortic valve incompetence. At follow-up mild incompetence persisted in 27 and moderate incompetence in 6 patients. In 1 patient it worsened from no incompetence to mild and in another patient from mild to moderate. The probability of aortic incompetence at follow-up was significantly and simultaneously related (multivariate ordinal logistic model) to (1) older age at operation (logarithm of months, p = 0.007), (2) higher preoperative gradient (third power of milligrams of mercury, p = 0.0004), (3) preoperative cardiomegaly (p = 0.04), and (4) surgical myectomy (p = 0.002). There was an interaction between age and gradient (p = 0.03). Two nomograms are proposed as a generalizable aid to decision making. The data support the policy of early repair of subaortic stenosis.