Outcomes of surgical treatment for congenital aortic stenosis in 145 children: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Yifan , JIANG Qi , ZHANG Wen , HU Renjie , YU Xiafeng ,  ZHANG Haibo

Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, P.R.China;

Corresponding author：

ZHANG Haibo, Email: zhanghaibosh@126.com

Keywords：

Congenital aortic stenosis; aortic insufficiency; aortic valve replacement; surgery

DOI：

10.7507/1007-4848.202005003

Video：

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Objective To explore the experience of surgical repair for congenital aortic stenosis (AS) in our center.Methods We retrospectively reviewed the clinical data of 145 children diagnosed with AS, who underwent aortic repair from 2008 to 2019, with or without aortic insufficiency (AI), including 104 males and 41 females with a median age of 2.9 (0.6, 7.8) years. The preoperative and intraoperative data, early and long-term valvular function, long-term survival rate and freedom from reoperation and aortic valve replacment (AVR) were analyzed.Results There were 120 patients receiving commissurotomy, 15 valvuloplasty with extra pericardium patch, and 25 AVR. The mean follow-up time was 0.25-11.20 (4.2±2.8) years. Survival rate at 10 years was 92.3%. Freedom from reoperation and AVR was 63.2% and 60.4% respectively. Multivariate analysis revealed that using a patch during surgery (P=0.036) was an independent risk factor for reoperation. A history of preoperative balloon dilation (P=0.029) and significant preoperative AI (P=0.001) contributed to AVR.Conclusion Surgical treatment of congenital aortic valve stenosis in children is a safe and effective method that provides enough time to achieve a more definitive solution. Using a patch during surgery increases reoperation hazard. A history of previous balloon dilation and significant preoperative AI may result in AVR during the follow-up.

Citation： ZHU Yifan, JIANG Qi, ZHANG Wen, HU Renjie, YU Xiafeng, ZHANG Haibo. Outcomes of surgical treatment for congenital aortic stenosis in 145 children: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(6): 675-681. doi: 10.7507/1007-4848.202005003 Copy

1.	Campbell M, Kauntze R. Congenital aortic valvular stenosis. Br Heart J, 1953, 15(2): 179-194.
2.	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.
3.	Boodhwani M, de Kerchove L, Glineur D, et al. Repair-oriented classification of aortic insufficiency: Impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg, 2009, 137(2): 286-294.
4.	Siddiqui J, Brizard CP, Konstantinov IE, et al. Outcomes after operations for bicuspid aortic valve disease in the pediatric population. Ann Thorac Surg, 2013, 96(6): 2175-2183.
5.	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.
6.	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.
7.	Benson L. Neonatal aortic stenosis is a surgical disease: An interventional cardiologist view. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2016, 19(1): 6-9.
8.	Prijic SM, Vukomanovic VA, Stajevic MS, et al. Balloon dilation and surgical valvotomy comparison in non-critical congenital aortic valve stenosis. Pediatr Cardiol, 2015, 36(3): 616-624.
9.	d'Udekem Y, Siddiqui J, Seaman CS, et al. Long-term results of a strategy of aortic valve repair in the pediatric population. J Thorac Cardiovasc Surg, 2013, 145(2): 461-467.
10.	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.
11.	Petit CJ, Gao K, Goldstein BH, et al. Relation of aortic valve morphologic characteristics to aortic valve insufficiency and residual stenosis in children with congenital aortic stenosis undergoing balloon valvuloplasty. Am J Cardiol, 2016, 117(6): 972-979.
12.	Buratto E, Shi WY, Wynne R, et al. Improved survival after the ross procedure compared with mechanical aortic valve replacement. J Am Coll Cardiol, 2018, 71(12): 1337-1344.
13.	Myers PO, Mokashi SA, Horgan E, et al. Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart disease. J Thorac Cardiovasc Surg, 2019, 157(1): 329-340.
14.	Donald JS, Wallace FRO, Naimo PS, et al. Ross operation in children: 23-year experience from a single institution. Ann Thorac Surg, 2020, 109(4): 1251-1259.
15.	Sharabiani MT, Dorobantu DM, Mahani AS, et al. Aortic valve replacement and the ross operation in children and young adults. J Am Coll Cardiol, 2016, 67(24): 2858-2870.
16.	Rossi RI, Manica JL, Petraco R, et al. Balloon aortic valvuloplasty for congenital aortic stenosis using the femoral and the carotid artery approach: A 16-year experience from a single center. Catheter Cardiovasc Interv, 2011, 78(1): 84-90.

1. Campbell M, Kauntze R. Congenital aortic valvular stenosis. Br Heart J, 1953, 15(2): 179-194.
2. 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.
3. Boodhwani M, de Kerchove L, Glineur D, et al. Repair-oriented classification of aortic insufficiency: Impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg, 2009, 137(2): 286-294.
4. Siddiqui J, Brizard CP, Konstantinov IE, et al. Outcomes after operations for bicuspid aortic valve disease in the pediatric population. Ann Thorac Surg, 2013, 96(6): 2175-2183.
5. 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.
6. 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.
7. Benson L. Neonatal aortic stenosis is a surgical disease: An interventional cardiologist view. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2016, 19(1): 6-9.
8. Prijic SM, Vukomanovic VA, Stajevic MS, et al. Balloon dilation and surgical valvotomy comparison in non-critical congenital aortic valve stenosis. Pediatr Cardiol, 2015, 36(3): 616-624.
9. d'Udekem Y, Siddiqui J, Seaman CS, et al. Long-term results of a strategy of aortic valve repair in the pediatric population. J Thorac Cardiovasc Surg, 2013, 145(2): 461-467.
10. 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.
11. Petit CJ, Gao K, Goldstein BH, et al. Relation of aortic valve morphologic characteristics to aortic valve insufficiency and residual stenosis in children with congenital aortic stenosis undergoing balloon valvuloplasty. Am J Cardiol, 2016, 117(6): 972-979.
12. Buratto E, Shi WY, Wynne R, et al. Improved survival after the ross procedure compared with mechanical aortic valve replacement. J Am Coll Cardiol, 2018, 71(12): 1337-1344.
13. Myers PO, Mokashi SA, Horgan E, et al. Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart disease. J Thorac Cardiovasc Surg, 2019, 157(1): 329-340.
14. Donald JS, Wallace FRO, Naimo PS, et al. Ross operation in children: 23-year experience from a single institution. Ann Thorac Surg, 2020, 109(4): 1251-1259.
15. Sharabiani MT, Dorobantu DM, Mahani AS, et al. Aortic valve replacement and the ross operation in children and young adults. J Am Coll Cardiol, 2016, 67(24): 2858-2870.
16. Rossi RI, Manica JL, Petraco R, et al. Balloon aortic valvuloplasty for congenital aortic stenosis using the femoral and the carotid artery approach: A 16-year experience from a single center. Catheter Cardiovasc Interv, 2011, 78(1): 84-90.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Outcomes of surgical treatment for congenital aortic stenosis in 145 children: A retrospective cohort study

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