Aortic valvotomy for congenital valvular aortic stenosis: a 37-year experience

doi:10.1016/S0003-4975(01)02398-0

The Annals of Thoracic Surgery

Volume 71, Issue 5, May 2001, Pages 1564-1571

https://doi.org/10.1016/S0003-4975(01)02398-0 Get rights and content

Abstract

Background. The purpose of the study was to analyze the long-term results of aortic valvotomy and the risk factors associated with reoperation and survival.

Methods. From 1960 to 1977, 116 patients with congenital valvular aortic stenosis underwent isolated aortic valvotomy at a mean age of 13.7 ± 7.8 years with a mean aortic gradient of 78 ± 33 mm Hg. Fifteen patients had additional aortic regurgitation, and leaflet calcification was present in another 15 patients.

Results. Postoperatively the mean aortic gradient decreased to 19.4 ± 11.3 mm Hg (p < 0.0001). Early mortality was 2.6%. At a mean follow-up of 23.8 years, 26 late deaths (22.4%) occurred among the 113 early survivors. Actuarial 10-, 20-, 30-, and 37-year survival rates were 94.6%, 79.7%, 76.2%, and 72.5%, respectively. According to multivariate Cox regression analysis, survival was influenced by preoperative New York Heart Association class (p = 0.0418), leaflet calcification (p = 0.0339), date of operation (p = 0.0253), and postoperative endocarditis (p < 0.0001). At a mean interval of 18.3 years, 37 patients required reoperation (31.9%) mainly because of recurrent aortic stenosis. The reoperation rate increased significantly 15 years postoperatively from 0.73%/year to 2.31%/year (p < 0.0001). In a multivariate risk model, reoperation was influenced by older patient age (p = 0.0032) and the presence of leaflet calcification (p = 0.0289).

Conclusions. Aortic valvotomy is a simple and effective procedure for congenital aortic stenosis with excellent long-term results. However, the rate of reoperation increases 15 years postoperatively, and clinical follow-up should be intensified. Our results suggest that early repair should be performed and that adequate patient selection is the most important determinant of the long-term results.

Section snippets

Patients and methods

From January 1960 to March 1977, 116 patients with congenital valvular aortic stenosis underwent isolated aortic valvotomy at our institution as their first surgical procedure. The mean age at operation was 13.7 ± 7.8 years (median, 13.0 years; range, 0.1 to 30 years). Four patients were younger than 1 year of age; none of them had critical aortic stenosis. There were 85 male and 31 female patients. The majority of patients (73%) were in New York Heart Association (NYHA) functional class II or

Postoperative results

The mean preoperative aortic pressure gradient decreased from 77.6 ± 32.5 mm Hg (range, 40 to 200 mm Hg) to 19.4 ± 11.3 mm Hg (range, 0 to 60 mm Hg) postoperatively (p < 0.0001). Twelve patients (10.3%) had postoperative gradients between 30 and 40 mm Hg and 1 patient (0.9%) still had a significant aortic gradient of 60 mm Hg. He died 3 months after the operation because of severe anticoagulant-related cerebral hemorrhage. There was no significant difference in preoperative (p = 0.976) and

Comment

The present study demonstrates that aortic valvotomy is a simple, safe, and effective procedure for congenital aortic stenosis offering good long-term results up to 37 years.

The early mortality rate was low and comparable to other investigators 6, 7, 8, 15, 16 even in the early years of cardiac operations, when cardioplegic solutions were not used. This is because of the fact that this technique is simple and easy to perform, which is well supported by the short aortic cross-clamp and CPB

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Original article: cardiovascularAortic valvotomy for congenital valvular aortic stenosis: a 37-year experience

Abstract

Section snippets

Patients and methods

Postoperative results

Comment

Am J Cardiol

J Thorac Surg

J Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Am J Cardiol

Ann Thorac Surg

Am J Cardiol

J Thorac Cardiovasc Surg

Original article: cardiovascular
Aortic valvotomy for congenital valvular aortic stenosis: a 37-year experience