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Eur J Cardiothorac Surg 2006;30:35-40
© 2006 Elsevier Science NL

Twenty years experience of surgical aortic valvotomy for critical aortic stenosis in early infancy

German Pediatric Heart Institute ("Deutsches Kinderherzzentrum"), Asklepios Klinik, Arnold-Janssen-Strasse, 29 53757 Sankt Augustin, Germany

Received 6 December 2005; received in revised form 24 March 2006; accepted 28 March 2006.

^_* Corresponding author. Tel.: +49 2241 249601; fax: +49 2241 249602. (Email: sinzo.md{at}dkhz.de).

Objective: To examine early and long-term results of surgical aortic valvotomy in neonates and infants aged less than 3 months. Methods: A review of all 34 neonates (n = 26) and young infants (n = 8) aged 1–62 days undergoing primary open valvotomy for aortic valve stenosis between 1983 and 2003 was carried out. Associated major cardiac anomalies were endocardial fibroelastasis (n = 8), aortic coarctation (n = 3), subvalvular aortic stenosis (n = 2), and ventricular septal defect (n = 1). Risk factors for early mortality were estimated. Current information was available for 31 patients for a follow-up of 115 ± 67 months. Kaplan–Meier method was used to estimate freedom from reintervention. Results: Two neonates died early: operative mortality of 6% (2/34). Risk factors for early mortality were associated endocardial fibroelastosis, monocuspid aortic valve and impaired left ventricular function. No patient died late. Seven patients needed reintervention for re-aortic stenosis (n = 5) or aortic insufficiency (n = 2), i.e., re-valvotomy (n = 3), valve replacement (n = 2), Ross procedure (n = 1), and balloon valvuloplasty (n = 1). Freedom from reintervention was 85.1 ± 6.9%, 78.0 ± 9.35%, and 53.5 ± 15.9% at 5, 10, and 15 years, respectively. Conclusions: Primary surgical aortic valvotomy in early infancy carries a low early and late mortality, a low occurrence of significant aortic regurgitation and a low early recurrence of aortic stenosis. In great majority of cases, reintervention can be delayed to allow implantation of an adult-sized prosthesis, when required.

Key Words: Critical aortic stenosis • Surgical aortic valvotomy • Long-term outcomes

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