Abstract
Recurrence of subaortic stenosis (SubAS) is up to ~ 19% following resection. Historically, treatment has consisted of membrane resection alone. This study investigated the effect of routine septal myectomy in addition to membrane resection. A single-center retrospective review was performed in all patients < 18 years of age undergoing membrane resection with septal myectomy for SubAS from 2003 to 2013. Demographic, perioperative, and follow-up data were collected. Freedom from reoperation and risk factors for reoperation were determined. 107 patients (median age 4.8 years) were included. There was one in-hospital death, five patients (5%) requiring pacemaker, and no iatrogenic ventricular septal defects. Follow-up was 80% complete and median follow-up was 4.9 years (range 0.5–12 years). Fourteen (16%) subjects required reoperation. Freedom from reoperation was 98% at 1 year, 86% at 5 years, and 69% at 10 years (Fig. 1). There was no difference in decrease of peak gradient between subjects who did and did not require reoperation (− 47 vs. − 40 mmHg; p = 0.59). In univariate analysis, chromosomal anomaly (hazard ratio [HR] 5.0, p = 0.02), smaller body surface area (HR 0.1, p = 0.03), and younger age at surgery (HR 0.7, p = 0.01) were significantly associated with reoperation. The routine use of myectomy with membrane excision did not result in a lower rate of reoperation or higher rates of complications compared to historical controls. Younger age, smaller size, and chromosomal anomaly were associated with increased risk for reoperation. Patients with these risk factors may benefit from more intensive long-term follow-up.
Similar content being viewed by others
Abbreviations
- AI:
-
Aortic insufficiency
- ASD:
-
Atrial septal defect
- AVSD:
-
Atrioventricular septal defect
- CI:
-
Confidence interval
- HR:
-
Hazard ratio
- LVOT:
-
Left ventricular outflow tract
- N/A:
-
Not applicable
- PDA:
-
Patent ductus arteriosus
- Ref:
-
Reference category
- VSD:
-
Ventricular septal defect
References
Kitchiner D, Jackson M, Malaiya N, Walsh K, Peart I, Arnold R (1994) Incidence and prognosis of obstruction of the left ventricular outflow tract in Liverpool (1960-91): a study of 313 patients. Br Heart J 71(6):588–595
Leichter D, Sullivan I, Gersony WM (1989) “Acquired” discrete subvalvular aortic stenosis: natural history and hemodynamics. J Am Coll Cardiol 14(6):1539–1544
Gewillig M, Daenen W, Dumoulin M, Van der Hauwaert L (1992) Rheologic genesis of discrete subvalvular aortic stenosis: a Doppler echocardiographic study. J Am Coll Cardiol 19(4):818–824
Newfield E, Muster J, Paul MH, Idriss FS, Riker WL (1976) Discrete subvalvular aortic stenosis in childhood. Study of 51 patients. Am J Cardiol 38(1):53–61
Lupinetti FM (2004) Left ventricular outflow tract obstruction. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 7:102–106
Aboulhosn J, Child JS (2006) Left ventricular outflow obstruction: subaortic stenosis, bicuspid aortic valve, supravalvar aortic stenosis, and coarctation of the aorta. Circulation 114(22):2412–2422
Attie F, Ovseyevitz J, Buendia A, Soto R, Richhemier R, Chavez-Dominguez R, Barragan R (1986) Surgical results in subaortic stenosis. Int J Cardiol 11(3):329–335
Lupinetti FM, Pridjian K, Callow LB, Crowley DC, Beekman RH, Bove EL (1992) Optimum treatment of discrete subaortic stenosis. Ann Thorac Surg 54(3):467–470 (discussion 470–471)
Rohlicek CV, del Pino SF, Hosking M, Miro J, Côté JM, Finley J (1999) Natural history and surgical outcomes for isolated discrete subaortic stenosis in children. Heart 82(6):708–713
Karamlou T, Gurofsky R, Bojcevski A et al (2007) Prevalence and associated risk factors for intervention in 313 children with subaortic stenosis. Ann Thorac Surg 84(3):900–906
Hirata Y, Chen jM, Quaegebeur JM, Mosca RS (2009) The role of enucleation with or without septal myectomy for discrete subaortic stenosis. J Thorac Cardiovasc Surg 137(5):1168–1172
Parry AJ, Kovalchin JP, Suda K et al (1999) Resection of subaortic stenosis; can a more aggressive approach be justified? Eur J Cardio-thoracic Surg 15(5):631–638
Rayburn ST, Netherland DE, Heath BJ (1997) Discrete membranous subaortic stenosis: improved resulted after resection and myectomy. Ann Thorac Surg 64(1):105–109
Darcin OT, Yagdi T, Atay Y et al (2003) Discrete subaortic stenosis: surgical outcomes and follow-up results. Tex Heart Inst J 30(4):286–292
Van Der Linde D, Roos-Hesselink JW, Rizopoulos D et al (2013) Surgical outcome of discrete subaortic stenosis in adults a multicenter study. Circulation 127(11):1184–1191
Brauner R, Laks H, Drinkwater DC, Shvarts O, Eghbali K, Galindo A (1997) Benefits of early surgical repair in fixed subaortic stenosis. J Am Coll Cardiol 30(70):1835–1842
Jou CJ, Etheridge SP, Minich LL, Saarel EV, Lambert LM, Kouretas PC, Holubkov R, Hawkins JA (2010) Long-term outcome and risk of heart block after surgical treatment of subaortic stenosis. World J Pediatr Congenit Heart Surg 1(1):15–19
Pickard SS, Geva A, Gauvreau K, del Nido PJ, Geva T (2015) Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children. Heart 101(19):1547–1553
Geva A, McMahon CJ, Gauvreau K, Mohammed L, del Nido PJ, Geva T (2007) Risk factors for reoperation after repair of discrete subaortic stenosis in children. J Am Coll Cardiol 50(15):1498–1504
Anderson BR, Tingo JE, Glickstein JS, Chai PJ, Bacha EA, Torres AJ (2017) When is it better to wait? Surgical timing and recurrence risk for children undergoing repair of subaortic stenosis. Pediatr Cardiol 38:1106–1114
Funding
The work was supported by the American Association for Thoracic Surgery’s Summer Intern Scholarship.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, the need for patient consent was waived.
Rights and permissions
About this article
Cite this article
Mazurek, A.A., Yu, S., Lowery, R. et al. Routine Septal Myectomy During Subaortic Stenosis Membrane Resection: Effect on Recurrence Rates. Pediatr Cardiol 39, 1627–1634 (2018). https://doi.org/10.1007/s00246-018-1941-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-018-1941-5