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. 2016 Aug 2;11(1):116.
doi: 10.1186/s13019-016-0509-9.

The mid-term outcome of primary open valvotomy for critical aortic stenosis in early infancy - a retrospective single center study over 18 years

Claire Galoin-Bertail  1 , André Capderou  2 , Emre Belli  3 , Lucile Houyel  2
Affiliations

The mid-term outcome of primary open valvotomy for critical aortic stenosis in early infancy - a retrospective single center study over 18 years

Claire Galoin-Bertail et al. J Cardiothorac Surg. .

Abstract

Background: The objective of this study was to examine early and long-term results of surgical aortic valvotomy in neonates and infants aged less than four months and to identify predictors of outcome.

Methods: Between August 1994 and April 2012, 83 consecutive patients younger than 4 months of age underwent open heart valvotomy for critical aortic stenosis in our institution. Median age was 17 days (range 0-111 days). We examined clinical records to establish determinants of outcome and illustrate long-term results.

Results: Fifty-six patients (67 %) were neonates. Associated cardiac malformations were found in 24 patients (29 %), including multilevel left heart obstruction in 5. The median follow-up was 4.2 years. The time-related survival rate was 87 and 85 % at 5 and 15 years, respectively. The time-related survival without reintervention was respectively 51, 35 and 18 % at 5, 10 and 15 years. The time-related survival without aortic valve replacement was respectively 67, 54 and 39 % at 5, 10 and 15 years. Ventricular dysfunction (p = 0.04), delayed sternal closure (p = 0.007), endocardial fibroelastosis (p = 0.02) and low z-score of the aortic annulus (p = 0.04) were found predictors of global mortality. Ventricular dysfunction (p = 0.01) and endocardial fibroelastosis (p = 0.04) were found predictors of reintervention.

Conclusions: The experience, in our center, on the management of critical aortic stenosis, shows a low early and late mortality, but the aortic valvotomy is a palliative procedure and we see unfortunately a high rate of reintervention among which the aortic valve replacement. These results suggest to reconsider the use of aortic balloon valvotomy, and particularly for the neonates with a low cardiac output in order to avoid the myocardial stress and the neurological injury due to the cardiopulmonary bypass.

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Figures

Fig. 1
Fig. 1
Survival curve after surgical aortic valvotomy
Fig. 2
Fig. 2
Time-related survival without re-intervention after surgical aortic valvotomy
Fig. 3
Fig. 3
Time-related survival without surgical re-intervention after surgical aortic valvotomy
Fig. 4
Fig. 4
Time-related survival without AVR after surgical aortic valvotomy
Fig. 5
Fig. 5
ROC curve of z-score of aortic annulus as risk factor of mortality
See this image and copyright information in PMC

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