Risk factors for reoperation after relief of congenital subaortic stenosis.

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Serval ID
serval:BIB_7BDF9E118CCD
Type
Article: article from journal or magazin.
Collection
Publications
Title
Risk factors for reoperation after relief of congenital subaortic stenosis.
Journal
European Journal of Cardio-thoracic Surgery
Author(s)
Dodge-Khatami A., Schmid M., Rousson V., Fasnacht M., Doell C., Bauersfeld U., Prêtre R.
ISSN
1010-7940 (Print)
ISSN-L
1010-7940
Publication state
Published
Issued date
2008
Peer-reviewed
Oui
Volume
33
Number
5
Pages
885-889
Language
english
Abstract
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.
Pubmed
Web of science
Open Access
Yes
Create date
16/12/2014 17:42
Last modification date
24/09/2019 7:57
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