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Long-term outcome of congenital aortic valve stenosis: predictors of reintervention

Published online by Cambridge University Press:  01 July 2014

Léa Hochstrasser ,
Patrick Ruchat ,
Nicole Sekarski ,
Michel Hurni  and
Ludwig K. von Segesser
Léa Hochstrasser*
Affiliation:
Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland
Patrick Ruchat
Affiliation:
Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland
Nicole Sekarski
Affiliation:
Pediatric Cardiology Unit, University Hospital, Lausanne, Switzerland
Michel Hurni
Affiliation:
Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland
Ludwig K. von Segesser
Affiliation:
Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland
*
Correspondence to: L. Hochstrasser, Walchestrasse 27, CH-8006 Zürich, Switzerland. Tel: +0041 78 913 22 44; Fax: +0041 21 314 36 65; E-mail: hochstrasserlea@gmail.com
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Abstract

Objectives: To evaluate long-term outcome of initial aortic valve intervention in a paediatric population with congenital aortic stenosis, and to determine risk factors associated with reintervention. Patients and methods: From 1985 to 2009, 77 patients with congenital aortic stenosis and a mean age of 5.8±5.6 years at diagnosis were followed up in our institution for 14.8±9.1 years. Results: First intervention was successful with 86% of patients having a residual peak aortic gradient <50 mmHg, and the proportion of patients with grade >1 regurgitation increased by 7%. Long-term survival after the first procedure was excellent, with 91% survival at 25 years. At a mean interval of 7.6±5.3 years, 30 patients required a reintervention (39%), mainly because of a recurrent aortic stenosis. Freedom from reintervention was 97, 89, 75, 53, and 42% at 1, 10, 15, 20, and 25 years, respectively. Predictors of reintervention were residual peak aortic gradient (p=0.0001), aortic regurgitation post-intervention >1 (p=0.02), prior balloon aortic valvuloplasty (p=0.04), and increased left ventricular posterior wall thickness (p=0.1). Conclusions: Aortic valve intervention is a safe and effective procedure for congenital aortic stenosis with excellent survival results. However, rate of reintervention is high and influenced by increased left ventricular posterior wall thickness pre-intervention, prior balloon valvuloplasty, higher residual peak systolic valve gradient, and more than mild regurgitation post-intervention. The study highlights that long-term follow-up is recommended for these patients.

Keywords

Congenital aortic valve stenosisballoon valvuloplastysurgical valvotomypredictors of reintervention
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 5 , June 2015 , pp. 893 - 902
Copyright
© Cambridge University Press 2014 

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