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[Valve replacement in congenital aortic stenosis]
Insights
Aortic valve replacement is a viable option for congenital aortic stenosis when severe calcification, endocarditis, or incompetence is present. Long-term outcomes for this procedure are favorable, emphasizing the need for infective endocarditis prevention.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Context:
- Congenital aortic stenosis often requires surgical intervention.
- Aortic valvotomy is the primary treatment, but aortic valve replacement (AVR) is sometimes necessary.
- This study analyzes AVR for congenital aortic stenosis between 1979-1995.
Purpose:
- To identify indications for AVR in congenital aortic stenosis.
- To determine the frequency of AVR procedures.
- To evaluate early and long-term results of AVR for congenital aortic stenosis.
Summary:
- Eighteen patients underwent AVR for congenital aortic stenosis.
- Indications included severe calcification, endocarditis, and associated regurgitation.
- Reoperations after prior valvotomy were performed in 8 patients.
- Hospital mortality was low (2 deaths), with 1 late death due to prosthetic endocarditis.
- Remaining 15 patients showed excellent long-term results (NYHA Class I-II).
Impact:
- Severely calcified aortic valves, endocarditis, and incompetence are key indications for AVR.
- Prophylaxis against infective endocarditis is crucial pre- and postoperatively.
- AVR offers very good long-term results for congenital aortic valve disease.
Background:
Hemodynamically significant congenital aortic stenosis is usually surgically solved by valvotomy, infrequently aortic valve replacement is necessary. The aim of this retrospective study (period 1979-1995) is to find reasons for valve replacement, frequency of these procedures and early and long term results after aortic valve replacement for congenital aortic stenosis.
Methods And Results:
Congenital aortic stenosis was solved by aortic valvotomy in 82 patients and by aortic valve replacement in 18 patients. Aortic valve replacement was performed 6x for congenital valvar aortic stenosis with mean aortic gradient 53.7 +/- 13.9 mm Hg and aortic valve area 0.42 +/- 0.04 cm2/m2 and 4x for valvar and subvalvar stenosis with mean aortic gradient 87.0 +/- 31.3 mm Hg, valve area 0.45 +/- 0.03 cm2/m2 and associated regurgitation 44.7 +/- 25.6%. In the remaining 8 patients aortic valve replacement was performed as reoperation after aortic valvotomy (after 20 +/- 8.4 years). In this group mean aortic gradient was only 32.2 +/- 13.8 mm Hg but regurgitation was 54.0 +/- 15.8%. Infective endocarditis occurred in 8 patients (44.5%) preoperatively. There were two hospital deaths (sudden death and multiorgan failure) and one death 3 years after operation (prosthetic endocarditis). Remaining 15 patients are in very good condition (NYHA I.-II.) 1-13 years after aortic valve replacement.
Conclusions:
Severely calcified aortic valve, endocarditis and associated incompetence are indications for valve replacement in patients with congenital aortic valve disease. Prevention of infective endocarditis is necessary pre and postoperatively, too. Long-term results after valve replacement for aortic valve stenosis are very good.