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Long-term results after valvotomy for congenital aortic valvar stenosis in children

Published online by Cambridge University Press:  19 August 2008

Virginie Lambert ,
Daniela Obreja ,
Jean Losay ,
Anita Touchot-Koné ,
Jean-Dominique Piot ,
Alain Serraf ,
François Lacour-Gayet  and
Claude Planche
Virginie Lambert*
Affiliation:
Marie Lannelongue Hospital, Le Plessis-Robinson, France
Daniela Obreja
Affiliation:
Marie Lannelongue Hospital, Le Plessis-Robinson, France
Jean Losay
Affiliation:
Marie Lannelongue Hospital, Le Plessis-Robinson, France
Anita Touchot-Koné
Affiliation:
Marie Lannelongue Hospital, Le Plessis-Robinson, France
Jean-Dominique Piot
Affiliation:
Marie Lannelongue Hospital, Le Plessis-Robinson, France
Alain Serraf
Affiliation:
Marie Lannelongue Hospital, Le Plessis-Robinson, France
François Lacour-Gayet
Affiliation:
Marie Lannelongue Hospital, Le Plessis-Robinson, France
Claude Planche
Affiliation:
Marie Lannelongue Hospital, Le Plessis-Robinson, France
*
Virginie Lambert Centre Chirurgical Marie Lannelongue, 133 avenue de la Resistance, 92350 Le Plessis-Robmson, France. Tel: (33) 0140942800; Fax: (33)0140942898, E-mail: [email protected]
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Abstract

As interest increase in the Ross procedure performed as a therapeutic option for children with congenital aortic valvar stenosis, it becomes increasinly important to know the late results of aortic valvotomy in this population. We have therefore examined retrospectively the medical records of 121 consecutives survivors undergoing aortic valvotomy before 10 years of age between 1974 and 1992. The mean age at the first valvotomy was 29 months, with a range from 3 days to 10 years. The mean duration of follow up was 9.4 years, with a range from 1.6 to 22 years. Fifteen patients (12.3%; 70% CL: 10–16) died: 9 following reoperation, and 6 late after surgery. Death was related to the hearts in 86% of cases. The actuarial survival rate was 79% (70% CL: 72/84) at 10 years. Young age at the first valvotomy, and the number of procedures, emerged as risk factors of secondary mortality. Reoperations on the aortic valve, 73 in all, were required in 56 patients. The second procedure was done after a mean interval of 6 years, with a rangefrom 1 day to 18 years. This was for restenosis in three-quarters of the cases. The aortic valve was replaced in 30 patients, at a mean of 9 years, and with a range from 9 months to 18 years, after the first procedure. The survival without replacement at 20 years was 29% (70% CL: 15–49). No factor was identified with a relationship either to reoperation or valvar replacement. Long term results after aortic valvotomy, therefore, show a high late mortality, frequent reinterventions, and an almost inescapable eventual need for valvar replacement. The ongoing use of the Ross operation is justified, even if longterm studies in children are still needed to validate its use.

Keywords

Ross procedureaortic valvar replacement, critical aortic stenosis.
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 6 , November 2000 , pp. 590 - 596
Copyright
Copyright © Cambridge University Press 2000

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References

1. Keane, JF, Driscoll, DJ, Gersony, WM, Hayes, CJ, Kidd, L, O'Fallon, WM, Pieroni, DR, Wolfe, RR, Weidman, WH. Second natural history study of congenital heart defects. Results of treatment of patients with aortic valvar stenosis. Circulation 1993; 87 [suppl1[.) 16–27.Google Scholar
2. Elkins, RC. Congenital aortic valve disease, evolving management. Ann Thorac Surg 1995; 59: 269–274.CrossRefGoogle ScholarPubMed
3. Wheller, JJ, Hosier, DM, Teske, DW, Craenen, JM, Kilman, JW. Results of operation for aortic valve stenosis in infants, children, and adolescents. J Thorac Cardiovasc Surg 1998; 96: 474–477.CrossRefGoogle Scholar
4. Brown, JW, Stevens, LS, Holly, S, Robison, R, Rodefeld, M, Grayson, T, Marts, B, Caldwell, RA, Hurwitz, RA, Girod, DA, King, H. Surgical spectrum of aortic stenosis in children: a thirty-year experience with 257 children. Ann Thorac Surg 1988; 45: 393–403.CrossRefGoogle ScholarPubMed
5. Elkins, RC, Knott-Craig, CJ, McCue, C, Lane, MM. Congenital aortic valve disease. Improved survival and quality of life. Annals of Surgery 1997; 225: 503–511.CrossRefGoogle ScholarPubMed
6. Chambers, JC, Somerville, J, Stone, S, Ross, DN. Pulmonary autograft procedure for aortic valve disease. Long-term results of the pioneer series. Circulation 1997; 96: 2206–2214.CrossRefGoogle ScholarPubMed
7. The Ross procedure: Current Registry results. Oury, JH, Hiro, SP, Maxwell, JM, Lamberti, JJ, Duran, CMG. Ann Thorac Surg 1998; S162–165.CrossRefGoogle Scholar
8. Hawkins, JA, Mmich, LL, Tani, LY, Day, RW, Judd, VE, Shaddy, RE, McGough, EC. Late results and reintervention after aortic valvotomy for critical aortic stenosis in neonates and infants. Ann Thorac Surg 1998; 65: 1758–1763.CrossRefGoogle ScholarPubMed
9. Chartrand, CC, Saro-Servando, E, Vobecky, JS. Long-term results of surgical valvuloplasty for congenital valvar aortic stenosi in children. Ann Thorac Surg 1999, 68: 1356–1360.CrossRefGoogle ScholarPubMed
10. Kitchiner, D, Sreeram, N, Malaiya, N, Jackson, M, Walsh, K, Peart, I, Arnold, R. Long-term follow-up of treated critical aortic stenosis. Cardiol Young 1995, 5: 9–14.CrossRefGoogle Scholar
11. Lakier, JB, Lewis, AB, Heymann, MA, Stanger, P, Hoffman, JIE, Rudolph, AM. Isolated aortic stenosis in the neonate. Natural history and hemodynamic considerations. Circulation 1974;50. 801–808.CrossRefGoogle ScholarPubMed
12. Pelech, AN, Dyck, JD, Trusler, GA, Williams, WG, Olley, PM, Rowe, RD, Freedom, RM. Critical aortic stenosis. Survival and management. J Thorac Cardiovasc Surg 1987; 94. 510–517.Google Scholar
13. Rhodes, LA, Colan, SD, Perry, SB, Jonas, RA, Sanders, SP. Predictors of survival in neonates with critical aortic stenosis. Circulation 1991; 84: 2325–2335Google Scholar
14. Mosca, RS, Iannettoni, MD, Schwartz, SM, Ludomirsky, A, Beekman III, RH, Lloyd, T, Bove, EL. Critical aortic stenosis in the neonate. A comparison of balloon valvuloplasty and transventricular dilatation. J Thorac Cardiovasc Surg 1995; 109: 147–154.CrossRefGoogle Scholar
15. Presbitero, P, Somerville, J, Revel-Chion, R, Ross, D. Open aortic valvotomy for congenital aortic stenosis. Late results. Br Heart J 1982; 47. 26–34.CrossRefGoogle ScholarPubMed
16. Gaynor, JW, Bull, C, Sullivan, ID, Armstrong, BE, Deanfield, JE, Taylor, JFN, Rees, PG, Ungerlieder, RM, De Leval, MR, Stark, J, Elliott, MJ. Late outcome of survivors of intervention for neonatal aortic valve stenosis. Ann Thorac Surg 1995; 60. 122–126CrossRefGoogle ScholarPubMed
17. El Makhlouf, A, Friedli, B, Oberhansli, I, Rouge, JC, Faidutti, B. Prosthetic heart valve replacement in children. J Thorac Cardiovasc Surg 1987; 93: 80–85.CrossRefGoogle ScholarPubMed
18. Elkins, RC, Knott-Craig, CJ, Ward, KE, Lane, MM. The Ross operation in children. 10-year experience. Ann Thorac Surg 1998; 65: 496–50.CrossRefGoogle Scholar
19. Barratt-Boyes, BG, Roche, AHG, Subramanyan, R, Pemberton, JR, Whitlock, RML. Long-term follow-up of patients with the antibiotic-sterilized aortic homograft valve inserted freehand into the aortic position. Circulation 1987; 75: 768–777CrossRefGoogle ScholarPubMed
20. Van Son, JAM, Reddy, VM, Black, MD, Rajasinghe, H, Haas, GS, Hanley, FL. Morphologic determinants favoring surgical aortic valvuloplasty versus pulmonary autograft aortic valve replacement in children. J Thorac Cardiovasc Surgery 1996; 111: 1149–1157.Google Scholar
21. Elkins, RC. The Ross operaration: a 12-year experience. Ann Thorac Surg 1999, 68: S14–18.Google Scholar