Surgical outcomes of severe aortic stenosis in infants_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GONG Dingxu , ZHANG Benqing , LIN Ye , ZHANG Lin , MA Kai , LIU Rui , LI Hanmei , RUI Lu ,  LI Shoujun

Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

LI Shoujun, Email: drlishoujunfw@163.com

Keywords：

Infants; aortic stenosis; aortic valvulotomy; follow-up

DOI：

10.7507/1007-4848.202003075

Video：

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Objective To analyze the results of surgical treatment of severe aortic stenosis in infants.Methods From August 2012 to December 2019, 28 infants undergoing aortic valvuloplasty in our hospital were selected, including 22 males and 6 females, aged 62.00 (47.00, 82.50) d. The baseline characteristics of the patients, postoperative complications and follow-up results were analyzed.Results Twenty (71.43%) patients had bicuspid aortic valves. Five (17.86%) patients had heart failure and two (7.14%) patients used prostaglandin before surgeries. Postoperative mechanical ventilation time was 25.00 (17.00, 62.75) h, ICU stay was 3.50 (2.00, 8.50) d and postoperative hospital stay was 10.00 (7.00, 16.50) d. Four (14.29%) patients got delayed recovery (ICU stay>14 d). One (3.57%) perioperative death was observed. The follow-up time was 55.00 (43.25, 82.25) months. No death was found during follow-up. Four (14.81%) patients underwent a second operation, including three (11.11%) patients with severe aortic stenosis, and one (3.70%) patient with severe regurgitation.Conclusion Infants with severe aortic stenosis are seriously ill and have a long postoperative recovery time, requiring early surgery. The postoperative follow-up results are satisfactory.

Citation： GONG Dingxu, ZHANG Benqing, LIN Ye, ZHANG Lin, MA Kai, LIU Rui, LI Hanmei, RUI Lu, LI Shoujun. Surgical outcomes of severe aortic stenosis in infants. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(1): 60-63. doi: 10.7507/1007-4848.202003075 Copy

1.	Lakier JB, Lewis AB, Heymann MA, et al. Isolated aortic stenosis in the neonate. Natural history and hemodynamic considerations. Circulation, 1974, 50(4): 801-808.
2.	Drury NE, Veldtman GR, Benson LN. Neonatal aortic stenosis. Expert Rev Cardiovasc Ther, 2005, 3(5): 831-843.
3.	Kjellberg Olofsson C, Berggren H, Söderberg B, et al. Treatment of valvular aortic stenosis in children: a 20-year experience in a single institution. Interact Cardiovasc Thorac Surg, 2018, 27(3): 410-416.
4.	Lofland GK, McCrindle BW, Williams WG, et al. Critical aortic stenosis in the neonate: a multi-institutional study of management, outcomes, and risk factors. Congenital Heart Surgeons Society. J Thorac Cardiovasc Surg, 2001, 121(1): 10-27.
5.	Kallio M, Rahkonen O, Mattila I, et al. Congenital aortic stenosis: treatment outcomes in a nationwide survey. Scand Cardiovasc J, 2017, 51(5): 277-283.
6.	Bhabra MS, Dhillon R, Bhudia S, et al. Surgical aortic valvotomy in infancy: impact of leaflet morphology on long-term outcomes. Ann Thorac Surg, 2003, 76(5): 1412-1416.
7.	McCrindle BW, Blackstone EH, Williams WG, et al. Are outcomes of surgical versus transcatheter balloon valvotomy equivalent in neonatal critical aortic stenosis? Circulation, 2001, 104(12 Suppl 1): I152-I158.
8.	Alexiou C, Langley SM, Dalrymple-Hay MJ, et al. Open commissurotomy for critical isolated aortic stenosis in neonates. Ann Thorac Surg, 2001, 71(2): 489-493.
9.	Fratz S, Gildein HP, Balling G, et al. Aortic valvuloplasty in pediatric patients substantially postpones the need for aortic valve surgery: a single-center experience of 188 patients after up to 17.5 years of follow-up. Circulation, 2008, 117(9): 1201-1206.
10.	Ou-Yang WB, Li SJ, Xie YQ, et al. Hybrid balloon valvuloplasty for the treatment of severe congenital aortic valve stenosis in infants. Ann Thorac Surg, 2018, 105(1): 175-180.
11.	Egito ES, Moore P, O'Sullivan J, et al. Transvascular balloon dilation for neonatal critical aortic stenosis: early and midterm Results. J Am Coll Cardiol, 1997, 29(2): 442-447.
12.	Siddiqui J, Brizard CP, Galati JC, et al. Surgical valvotomy and repair for neonatal and infant congenital aortic stenosis achieves better results than interventional catheterization. J Am Coll Cardiol, 2013, 62(22): 2134-2140.
13.	Brown JW, Rodefeld MD, Ruzmetov M, et al. Surgical valvuloplasty versus balloon aortic dilation for congenital aortic stenosis: are evidence-based outcomes relevant? Ann Thorac Surg, 2012, 94(1): 146-153.
14.	Hochstrasser L, Ruchat P, Sekarski N, et al. Long-term outcome of congenital aortic valve stenosis: predictors of reintervention. Cardiol Young, 2015, 25(5): 893-902.
15.	Vergnat M, Asfour B, Arenz C, et al. Aortic stenosis of the neonate: a single-center experience. J Thorac Cardiovasc Surg, 2019, 157(1): 318-326.

1. Lakier JB, Lewis AB, Heymann MA, et al. Isolated aortic stenosis in the neonate. Natural history and hemodynamic considerations. Circulation, 1974, 50(4): 801-808.
2. Drury NE, Veldtman GR, Benson LN. Neonatal aortic stenosis. Expert Rev Cardiovasc Ther, 2005, 3(5): 831-843.
3. Kjellberg Olofsson C, Berggren H, Söderberg B, et al. Treatment of valvular aortic stenosis in children: a 20-year experience in a single institution. Interact Cardiovasc Thorac Surg, 2018, 27(3): 410-416.
4. Lofland GK, McCrindle BW, Williams WG, et al. Critical aortic stenosis in the neonate: a multi-institutional study of management, outcomes, and risk factors. Congenital Heart Surgeons Society. J Thorac Cardiovasc Surg, 2001, 121(1): 10-27.
5. Kallio M, Rahkonen O, Mattila I, et al. Congenital aortic stenosis: treatment outcomes in a nationwide survey. Scand Cardiovasc J, 2017, 51(5): 277-283.
6. Bhabra MS, Dhillon R, Bhudia S, et al. Surgical aortic valvotomy in infancy: impact of leaflet morphology on long-term outcomes. Ann Thorac Surg, 2003, 76(5): 1412-1416.
7. McCrindle BW, Blackstone EH, Williams WG, et al. Are outcomes of surgical versus transcatheter balloon valvotomy equivalent in neonatal critical aortic stenosis? Circulation, 2001, 104(12 Suppl 1): I152-I158.
8. Alexiou C, Langley SM, Dalrymple-Hay MJ, et al. Open commissurotomy for critical isolated aortic stenosis in neonates. Ann Thorac Surg, 2001, 71(2): 489-493.
9. Fratz S, Gildein HP, Balling G, et al. Aortic valvuloplasty in pediatric patients substantially postpones the need for aortic valve surgery: a single-center experience of 188 patients after up to 17.5 years of follow-up. Circulation, 2008, 117(9): 1201-1206.
10. Ou-Yang WB, Li SJ, Xie YQ, et al. Hybrid balloon valvuloplasty for the treatment of severe congenital aortic valve stenosis in infants. Ann Thorac Surg, 2018, 105(1): 175-180.
11. Egito ES, Moore P, O'Sullivan J, et al. Transvascular balloon dilation for neonatal critical aortic stenosis: early and midterm Results. J Am Coll Cardiol, 1997, 29(2): 442-447.
12. Siddiqui J, Brizard CP, Galati JC, et al. Surgical valvotomy and repair for neonatal and infant congenital aortic stenosis achieves better results than interventional catheterization. J Am Coll Cardiol, 2013, 62(22): 2134-2140.
13. Brown JW, Rodefeld MD, Ruzmetov M, et al. Surgical valvuloplasty versus balloon aortic dilation for congenital aortic stenosis: are evidence-based outcomes relevant? Ann Thorac Surg, 2012, 94(1): 146-153.
14. Hochstrasser L, Ruchat P, Sekarski N, et al. Long-term outcome of congenital aortic valve stenosis: predictors of reintervention. Cardiol Young, 2015, 25(5): 893-902.
15. Vergnat M, Asfour B, Arenz C, et al. Aortic stenosis of the neonate: a single-center experience. J Thorac Cardiovasc Surg, 2019, 157(1): 318-326.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical outcomes of severe aortic stenosis in infants

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