Risk factors for reoperation after relief of congenital subaortic stenosis
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Risk factors for reoperation after relief of congenital subaortic stenosis. / Dodge-Khatami, Ali; Schmid, Michael; Rousson, Valentin; Fasnacht, Margrit; Doell, Carsten; Bauersfeld, Urs; Prêtre, René.
in: EUR J CARDIO-THORAC, Jahrgang 33, Nr. 5, 05.2008, S. 885-889.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Risk factors for reoperation after relief of congenital subaortic stenosis
AU - Dodge-Khatami, Ali
AU - Schmid, Michael
AU - Rousson, Valentin
AU - Fasnacht, Margrit
AU - Doell, Carsten
AU - Bauersfeld, Urs
AU - Prêtre, René
PY - 2008/5
Y1 - 2008/5
N2 - BACKGROUND: Congenital subaortic stenosis entails a lesion spectrum, ranging from an isolated obstructive membrane, to complex tunnel narrowing of the left outflow associated with other cardiac defects. We review our experience with this anomaly, and analyze risk factors leading to restenosis requiring reoperation.METHODS: From 1994 to 2006, 58 children (median age 4.3 years, range 7 days-13.7 years) underwent primary relief of subaortic stenosis. Patients were divided into simple lesions (n=43) or complex stenosis (n=15) associated with other major cardiac defects. Age, pre- and postoperative gradient over the left outflow, associated aortic or mitral valve insufficiency, chromosomal anomalies, arteria lusoria, and operative technique (membrane resection (22) vs associated myectomy (34) vs Konno (2)) were analyzed as risk factors for reoperation (Kaplan-Meier, Cox regression).RESULTS: There was no operative mortality. Median follow-up spanned 2.7 years (range 0.1-10), with one late death at 4 months. Reoperation was required for recurrent stenosis in 11 patients (19%) at 2.6 years (range 0.3-7.5) after initial surgery. Risk factors for reoperation included complex subaortic stenosis (p=0.003), younger age (p=0.012), postoperative residual gradient (p=0.019), and the presence of an arteria lusoria (p=0.014). For simple lesions, no variable achieved significance for stenosis recurrence.CONCLUSIONS: Surgical relief of congenital subaortic stenosis, even with complex defects, yields excellent results. Reoperation is not infrequent, and should be anticipated with younger age at operation, complex defects, residual postoperative gradient, and an arteria lusoria. Myectomy concomitant to membrane resection, even in simple lesions, does not provide enhanced freedom from reoperation, and should be tailored to anatomic findings.
AB - BACKGROUND: Congenital subaortic stenosis entails a lesion spectrum, ranging from an isolated obstructive membrane, to complex tunnel narrowing of the left outflow associated with other cardiac defects. We review our experience with this anomaly, and analyze risk factors leading to restenosis requiring reoperation.METHODS: From 1994 to 2006, 58 children (median age 4.3 years, range 7 days-13.7 years) underwent primary relief of subaortic stenosis. Patients were divided into simple lesions (n=43) or complex stenosis (n=15) associated with other major cardiac defects. Age, pre- and postoperative gradient over the left outflow, associated aortic or mitral valve insufficiency, chromosomal anomalies, arteria lusoria, and operative technique (membrane resection (22) vs associated myectomy (34) vs Konno (2)) were analyzed as risk factors for reoperation (Kaplan-Meier, Cox regression).RESULTS: There was no operative mortality. Median follow-up spanned 2.7 years (range 0.1-10), with one late death at 4 months. Reoperation was required for recurrent stenosis in 11 patients (19%) at 2.6 years (range 0.3-7.5) after initial surgery. Risk factors for reoperation included complex subaortic stenosis (p=0.003), younger age (p=0.012), postoperative residual gradient (p=0.019), and the presence of an arteria lusoria (p=0.014). For simple lesions, no variable achieved significance for stenosis recurrence.CONCLUSIONS: Surgical relief of congenital subaortic stenosis, even with complex defects, yields excellent results. Reoperation is not infrequent, and should be anticipated with younger age at operation, complex defects, residual postoperative gradient, and an arteria lusoria. Myectomy concomitant to membrane resection, even in simple lesions, does not provide enhanced freedom from reoperation, and should be tailored to anatomic findings.
KW - Adolescent
KW - Aortic Stenosis, Subvalvular/mortality
KW - Aortic Valve/physiopathology
KW - Child
KW - Child, Preschool
KW - Follow-Up Studies
KW - Humans
KW - Infant
KW - Infant, Newborn
KW - Kaplan-Meier Estimate
KW - Proportional Hazards Models
KW - Recurrence
KW - Reoperation
KW - Retrospective Studies
KW - Risk Factors
KW - Stroke Volume
KW - Treatment Outcome
KW - Ventricular Function, Left
U2 - 10.1016/j.ejcts.2008.01.049
DO - 10.1016/j.ejcts.2008.01.049
M3 - SCORING: Journal article
C2 - 18314346
VL - 33
SP - 885
EP - 889
JO - EUR J CARDIO-THORAC
JF - EUR J CARDIO-THORAC
SN - 1010-7940
IS - 5
ER -