Congenital Aortic Stenosis. Early and Late Results of Aortic Valvulotomy

Abstract

Between 1962 and 1979, 87 patients with congenital aortic stenosis (11 infants from 4 days to 5 months, and 76 patients from one year to 24 years) underwent open aortic valvulotomy; in 14 patients an additional subvalvular membraneous ring or hypertrophic subaortic stenosis was resected. There were 3 early deaths (3%), all in infants less than one year of age. A second operation was necessary 3 months to 10 years (mean 6.3 +/- 4 years) after the initial procedure in 12 of the 84 survivors. In 9 patients an aortic valve replacement and in 3 patients a second valvulotomy was performed without perioperative mortality: in the latter group valve replacement had to be performed later. There were 5 late deaths (6%). The causes of death were endocarditis (2), thrombosis of the prosthesis (1), accident (1) and sudden death (1). The overall actuarial survival curve shows a 5-year survival of 90% and a 10-year survival of 87%; 87% are reoperation-free after 5 years and 75% after 8 years. At present 7 patients are scheduled for surgery because of recurrence of stenosis; 61 patients are symptom-free. It is concluded that aortic valvulotomy has immediate and long-term benefit in the large majority of patients. Operative mortality and morbidity are low in patients older than one year of age. Nevertheless aortic valvulotomy, which should not be performed too late, represents a palliative treatment and will lead to reoperation in approximately 25% of patients after 8 years.

Aortic Valvuloplasty in Pediatric Patients Substantially Postpones the Need for Aortic Valve Surgery

“…It is known that a significant number of patients after both AoVP [13][14][15] and aortic valve surgery [25][26][27][28][29] inevitably require aortic valve replacement for progressive aortic regurgitation at some point. However, no studies exist that allow a valid comparison of AoVP and aortic valve surgery.…”

Management of valvar aortic stenosis in children

“…[4][5][6][7][8][9][10][11][12] There are relatively recent reports of encouraging survival rates with both surgery and balloon valvotomy even in the troublesome neonatal group in which triage for a Norwood approach based on an improved understanding of the limits of a biventricular repair must have played a significant part. [12][13][14] Valvotomy of any kind is a palliative procedure and reintervention remains frequent.…”

“…In historical surgical series 15-40% of patients have required reintervention between 5-10 years after the initial valvotomy. [9][10][11] Undoubtedly over the 20 year story of balloon valvotomy, surgery, particularly of the left ventricular outflow tract, has improved significantly. There are a scattering of contemporary surgical reports describing excellent results with low reintervention rates (up to 90% free from reintervention at 10 years post-surgery).…”

Balloon aortic valvuloplasty in young adults by antegrade, transseptal approach using Inoue balloon

“…Follow up results of BAV in the elderly patients revealed a high incidence of restenosis and late mortality. However immediate and short-term results of BAV in younger patinets with congenital aortic stenosis were found to be satisfactory [7][8][9][10] and compare favourably with the results of surgical valvotomy [11]. In view of the encouraging long-term results indicated by some of the recent reports [12,13], the BAV has emerged as a feasible alternative to the surgical valvotomy in young patients.…”

“…BAV is an accepted alternative to surgical valvotomy for palliation of aortic stenosis in younger patients [1,2,[7][8][9][10][11]. It is aimed at preserving the left ventricular function and postponing the replacement of the aortic valve.…”