Original article
Cardiovascular
Outcome of Surgical Commissurotomy for Aortic Valve Stenosis in Early Infancy

https://doi.org/10.1016/j.athoracsur.2007.03.098Get rights and content

Background

The method of treatment of aortic valve stenosis in early infancy is still controversial. This study was performed to evaluate short-term and long-term outcome in our center during a 14-year period.

Methods

Between 1991 and 2004, 64 consecutive patients younger than 3 months old underwent open surgical commissurotomy because of aortic valve stenosis. Median age was 18 days (range, 1 to 79 days), and median weight was 3.6 kg (range, 1.9 to 6.7 kg). Left ventricular function was good in 44 patients (69%), depressed in 12 (19%), and poor in 8 (12%). The study ended in July 2005. Median follow-up time was 4.1 years (range, 0.4 to 13.6 years).

Results

The 30-day mortality was 3 of 64 patients and late mortality was 3 of 61, and the respective mortality in patients younger than 1 month old was 2 of 41 and 2 of 39. There was no early mortality after 1993 and no late mortality after 1999. Thirteen patients required reoperation. Median time to reoperation was 4.3 years (range, 0.2 to 11.3 years) and to aortic valve replacement (7 Ross and 1 homograft) was 6.9 years (range, 1.6 to 9.7 years). At the last follow-up, all had good left ventricular function and 57 of 58 had an ability index of 1.

Conclusions

Surgical commissurotomy for aortic valve stenosis during the first 3 months of life can be done with low mortality and morbidity. The risk for early recurrent stenosis or regurgitation is low, and the need for aortic valve replacement can, in most cases, be delayed until the child is older. The long-term functional ability is excellent.

Section snippets

Patients and Methods

This was a retrospective study of all patients who underwent operation because of aortic valve stenosis within the first 3 months of life at our institution from 1991 until 2004. The patients’ files were reviewed for data, including echocardiographic findings preoperatively, perioperatively, direct postoperatively, 6 to 12 months postoperatively, and at the patient’s last follow-up visit at the referring cardiologist. The study period ended in July 2005. Follow-up time was a median of 4.1 years

Mortality

The study period was divided into three time intervals: 1991 to 1995, 1996 to 2000, and 2001 to 2004. Figures for early mortality (within 30 days postoperatively) and late mortality are presented in Table 1. During the whole study period, the early mortality rate was 3 (5%) of 64 patients:

  • In 1991, a 63-day-old girl presented with tachypnea and poor left ventricular function. Inotropic support was initiated and she received mechanical ventilation before undergoing open commissurotomy.

Comment

Significant aortic valve stenosis in the newborn is a serious condition with high mortality in older series. This study shows that open commissurotomy in the neonate can currently be done with low mortality. Other centers also report very low or no early mortality in this group of patients treated surgically [2, 3], but with increased risk in patients with other associated cardiac lesions [4]. As other authors have suggested [5], one reason for a better outcome during the last decade, both

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