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J Thorac Cardiovasc Surg 1999;117:669-678
© 1999 Mosby, Inc.
SURGERY FOR CONGENITAL HEART DISEASE |
From the Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Le Plessis Robinson, France.
Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.
Received for publication May 8, 1998. Rrevisions requested June 30, 1998. Revisions received Nov 30, 1998. Accepted for publication Dec 2, 1998. Address for reprints: Alain Serraf, MD. Marie-Lannelongue Hospital, 133 avenue de la Résistance, 92350, Le Plessis Robinson, France.
Objective: The aim of the study was to analyze the long-term results of subaortic stenosis relief and the risk factors associated with recurrence and reoperation.
Methods: One hundred sixty patients with subaortic stenosis underwent biventricular repair. Before the operation the mean left ventricle–aorta gradient was 80 ± 35 mm Hg, 57 patients had aortic regurgitation, and 34 were in New York Heart Association functional class III or IV. Median age at repair was 10 years. For discrete subaortic stenosis (n = 120), 39 patients underwent isolated membranectomy, 67 underwent membranectomy with associated septal myotomy, and 14 underwent septal myectomy. Tunnel subaortic stenosis (n = 34) was treated by myotomy in 10 cases, myectomy in 12, septoplasty in 7, Konno procedure in 3, and apical conduit in 2. Aortic valve replacement was performed in 6 cases, mitral valve replacement in 2 cases, and mitral valvuloplasty in 4 cases.
Results: There were 5 early (3.1%) and 4 late (4.4%) deaths. Within 3.6 ± 3.3 years a recurrent gradient greater than 30 mm Hg was found in 42 patients (27%), 20 of whom had 26 reoperations. According to multivariable Cox regression analysis survival was influenced by hypoplastic aortic anulus (P = .01) and mitral stenosis (P = .048); recurrence and reoperation were influenced by coarctation and immediate postoperative left ventricular outflow tract gradients. At a median follow-up of 13.3 years, mean left ventricle–aorta gradient was 20 ± 13 mm Hg. Relief of the subaortic stenosis improved the degree of aortic regurgitation in 86% of patients with preoperative aortic regurgitation. Actuarial survival and freedom from reoperation rates at 15 years were 94% ± 1.3% and 85% ± 6%, respectively.
Conclusion: Although surgical treatment provides good results, recurrence and reoperation are significantly influenced by previous coarctation repair and by the quality of initial relief of subaortic stenosis.
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