Surgical aortic valvotomy in infancy: impact of leaflet morphology on long-term outcomes

Congenital Aortic Stenosis in Childhood

“…Early mortality after neonatal surgical aortic valvotomy was very high in the early experience but was significantly reduced in subsequent publications, with rates varying between 2.1% and 18% (Alexiou et al, 2001;Bhabra et al, 2003;Brown et al, 2003;Gildein et al, 1996;Hawkins et al, 1998;Miyamoto et al, 2006;Zain et al, 2006). Several risk factors for increased operative mortality include endocardial fibroelastosis, hypoplastic left ventricle, hypoplastic aortic annulus, associated cardiovascular anomalies, extremely small neonates, earlier era surgery, monocuspid aortic valve and impaired left ventricular function (Bhabra et al, 2003;Brown et al, 2006;Hawkins et al, 1998;Miyamoto et al, 2006). Similarly to what happens after balloon dilatation, progressive worsening of aortic insufficiency and re-stenosis occurs at long-term follow up after surgical valvotomy.…”

“…The freedom from reintervention is 80-85% after 5-7 years (Brown et al, 2006;Cobanoglu & Dobbs, 1996;Miyamoto et al, 2006), 55-78% after 10 years (Alexiou et al, 2001;Brown et al, 2006;Hawkins et al, 1998;Miyamoto et al, 2006) and 53-65% after 15-20 years (Brown et al, 2006;Miyamoto et al, 2006). Long-term survival rate is 74-100% at 5-10 years (Alexiou et al, 2001;Bhabra et al, 2003;Brown et al, 2003;Cowley et al, 2001;Gaynor et al, 1995;Hawkins et al, 1998) and 84-88% at 15-20 years (Brown et al, 2003;Gaynor et al, 1995). A retrospective review of infants undergoing primary surgical aortic valvotomy showed better long-term outcomes (in terms of survival and freedom from reintervention) when surgery resulted in trileaflet rather than bileaflet anatomy (Bhabra et al, 2003).…”

“…Long-term survival rate is 74-100% at 5-10 years (Alexiou et al, 2001;Bhabra et al, 2003;Brown et al, 2003;Cowley et al, 2001;Gaynor et al, 1995;Hawkins et al, 1998) and 84-88% at 15-20 years (Brown et al, 2003;Gaynor et al, 1995). A retrospective review of infants undergoing primary surgical aortic valvotomy showed better long-term outcomes (in terms of survival and freedom from reintervention) when surgery resulted in trileaflet rather than bileaflet anatomy (Bhabra et al, 2003).…”

The influence of valve physiology on outcome following aortic valvotomy for congenital bicuspid valve in children: 30-year results from a single institution

“…Significant residual aortic stenosis and regurgitation are well known problems after valvotomy, occurring in 10-43% of patients [1][2][3][4][5]. The hemodynamic consequences of these lesions are different, however, with aortic insufficiency (AI) producing chronic volume overload, and aortic stenosis (AS) producing chronic pressure-overload [6][7][8][9][10][11][12][13].…”

“…In addition, the increased risk of AI following percutaneous valvotomy, secondary to cusp or commissural damage, as compared to surgical valvotomy has renewed interest in defining criteria for timing of repeat intervention and optimizing patient selection [6,14]. Although numerous studies have elucidated risk factors for the development of aortic regurgitation or incomplete relief of obstruction, the natural history of these different post-valvotomy lesions with respect to ventricular function, reintervention, and long-term patient outcome remain uncertain [1][2][3][4][5][6][7]14].…”