Thorac Cardiovasc Surg 2014; 62 - SC92
DOI: 10.1055/s-0034-1367353

Subaortic stenosis after repair of complete atrioventricular septal defect: Anatomic and technical issues

E.M. Delmo Walter 1, M.F. Javier 2, O. Miera 3, R. Hetzer 1, V. Alexi-Meskishvilli 1
  • 1Deutsches Herzzentrum Berlin, Herz-,Thorax-u. Gefäßchirurgie, Berlin, Germany
  • 2Harvard University, Cambridge, United States
  • 3Deutsches Herzzentrum Berlin, Pediatric Cardiology/Congenital Heart Diseases, Berlin, Germany

Objective: This report reviews our institutional experience with subaortic stenosis developing after repair of complete atrioventricular septal defects (CAVSD). It aims to analyze whether subaortic stenosis is anatomically inherent or technically preventable.

Patients and methods: Between 1986 and 2012, 383 patients (median age 2.15 years, range 0-4.7 years) underwent biventricular correction of CAVSD.. During a median follow-up of 16.06 years (range 1-25 years), 89 (23.8%) patient underwent first reoperations, 33 (8%) underwent second reoperations , while 20 (5%), 10 (2.6%), 6 (1,6%) and 5 (1.3%) have had third, fourth, fifth and sixth reoperations, respectively. The most common causes of reoperations are left atrioventricular valve regurgitation, residual ventricular septal defect, subaortic stenosis and late onset complete heart bock.

Results: Nineteen patients (median age 6.25 years, range 0-23 years) developed subaortic stenosis. They had 26 reinterventions within 6 months-23 years after the initial surgery. Seventeen patients had severe subaortic stenosis (mean pressure gradient of 80 ± 20 mmHg) to warrant resection of the left ventricular outflow tract obstruction. A spectrum of surgical approaches have been employed and this will be described in detail as to which techniques employed have led to a higher incidence of subaortic stenosis. Freedom from reoperation is 100%, 82.3%, 35.3% and 17.6% at 30 days, 1, 5 and 15 years, respectively. Cumulative survival is 100% at 30 days and 1 year, and 81.3% at 5 and 16 years. The other 2 patients have mild subaorti stenosis (mean pressure gradient 10 ± 3 mmHg) hence, there is still no indication for surgery. In this series, the prevalence of subaortic stenosis is 4.9%.

Conclusion: The risk of developing subaortic obstruction after repair of the CAVSD is real and may occur commonly than previously reported. Anatomical and technical issues during the initial CAVSD correction should be meticulously dealt with to reduce the incidence of subaortic stenosis.