C C Chartrand1, E Saro-Servando, J S Vobecky. 1. Division of Cardiovascular Surgery, Sainte-Justine Hospital, Montreal, Quebec, Canada. chirhsj@point-net.com
Abstract
BACKGROUND: To question the validity of surgical aortic valvuloplasty for congenital aortic valve stenosis, a retrospective study was undertaken to determine the long-term survival, the incidence of valve restenosis or insufficiency, and the freedom of reoperation or valve replacement. METHODS: From January 1960 through 1992, 67 consecutive children diagnosed with congenital aortic valve stenosis underwent an open aortic valvuloplasty at our institution. Ages at operation ranged from 6 to 228 months (mean 105.7 +/- 52 months). The mean follow-up of these patients has been 127.5 +/- 66.7 months. RESULTS: There was no hospital mortality, but two late valve-related deaths occurred. Eight patients developed aortic regurgitation 5 to 125 months (mean 66.6 +/- 35 months) after surgical valvuloplasty, and 1 of them required aortic valve replacement. Because of restenosis, 16 patients required a second operation. Of them, 5 children underwent a second aortic valvuloplasty without mortality and, in 4 of them, the functional result has been excellent after a mean follow-up of 75.4 +/- 12 months. Eleven patients required an aortic valve replacement 62 to 208 months postop (mean 100.9 +/- 50.8 months). Mechanical prosthesis were used in 7 and bioprosthesis in 4. Two patients required a Konno and 1 required a Ross procedure. There were no early nor late deaths after reoperations. The probability of 20-year survival after the first valvuloplasty was 94%, the freedom of reoperation 63%, and the freedom of aortic valve replacement 73% for the same time period. CONCLUSIONS: Our results demonstrate that congenital aortic valvar stenosis in children can be surgically well controlled until adulthood. Our study also shows that surgical valvuloplasty is a safe and efficacious procedure and that its beneficial effect is maintained over 20 years in the majority of children.
BACKGROUND: To question the validity of surgical aortic valvuloplasty for congenital aortic valve stenosis, a retrospective study was undertaken to determine the long-term survival, the incidence of valve restenosis or insufficiency, and the freedom of reoperation or valve replacement. METHODS: From January 1960 through 1992, 67 consecutive children diagnosed with congenital aortic valve stenosis underwent an open aortic valvuloplasty at our institution. Ages at operation ranged from 6 to 228 months (mean 105.7 +/- 52 months). The mean follow-up of these patients has been 127.5 +/- 66.7 months. RESULTS: There was no hospital mortality, but two late valve-related deaths occurred. Eight patients developed aortic regurgitation 5 to 125 months (mean 66.6 +/- 35 months) after surgical valvuloplasty, and 1 of them required aortic valve replacement. Because of restenosis, 16 patients required a second operation. Of them, 5 children underwent a second aortic valvuloplasty without mortality and, in 4 of them, the functional result has been excellent after a mean follow-up of 75.4 +/- 12 months. Eleven patients required an aortic valve replacement 62 to 208 months postop (mean 100.9 +/- 50.8 months). Mechanical prosthesis were used in 7 and bioprosthesis in 4. Two patients required a Konno and 1 required a Ross procedure. There were no early nor late deaths after reoperations. The probability of 20-year survival after the first valvuloplasty was 94%, the freedom of reoperation 63%, and the freedom of aortic valve replacement 73% for the same time period. CONCLUSIONS: Our results demonstrate that congenital aortic valvar stenosis in children can be surgically well controlled until adulthood. Our study also shows that surgical valvuloplasty is a safe and efficacious procedure and that its beneficial effect is maintained over 20 years in the majority of children.