Surgery for simple and complex subaortic stenosis in children and young adults: Results from a prospective, procedure-based national database

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 148; no. 6; pp. 2618 - 2626
• Main Authors: Dorobantu, Dan M., MBBS, Sharabiani, Mansour T., PhD, Martin, Robin P., FRCP, Angelini, Gianni D., FRCS, Parry, Andrew J., FRCS, Caputo, Massimo, MD, Stoica, Serban C., FRCS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2014
• Subjects: Adolescent; Adult; Age Factors; Aortic Stenosis, Subvalvular - diagnosis; Aortic Stenosis, Subvalvular - mortality; Aortic Stenosis, Subvalvular - surgery; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - mortality; Cardiothoracic Surgery; Child; Child, Preschool; Databases, Factual; Hospital Mortality; Humans; Infant; Infant, Newborn; Kaplan-Meier Estimate; Postoperative Complications - mortality; Postoperative Complications - surgery; Proportional Hazards Models; Reoperation; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; United Kingdom; Young Adult; complex stenosis; SAS; HR; LV; subaortic stenosis; 20.2; mitral valve; left ventricular; ventricular septal defect; CCAD; AV replacement; SS; aortic valve; simple stenosis; CI; VSD; IAA; MV; interrupted aortic arch; CS; CoA; AV; hazard ratio; confidence interval; Central Cardiac Audit Database; AVR; aortic coarctation
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2014.06.091

Objective To identify the outcomes of surgically treated subaortic stenosis in a national population. Methods From 2000 to 2013, 1047 patients aged < 40 years underwent 1142 subaortic stenosis procedures. Of the 1047 patients, 484 (46.2%) were considered to have complex stenosis (CS) because at or before the first operation they had mitral valve (MV) disease, aortic valve disease, aortic coarctation or an interrupted aortic arch. Results The 30-day mortality was 0.7% for simple stenosis (SS), 2.3% for CS ( P  = .06), and 1.6% overall. Age < 1 year ( P  < .01), MV procedure ( P  = .02) and an interrupted aortic arch at the index procedure ( P  < .01) were risk factors for early death. Konno-type procedure early mortality was 2.4%. The 12-year survival was 97.1%, with a significant difference between SS and CS (hazard ratio [HR], 4.53; P  = .02). Having MV disease alone (HR, 4.11; P  = .02), MV disease plus aortic coarctation (HR, 6.73; P  = .008), and age < 1 year (HR, 6.72; P  < .001) were risk factors for late mortality. Freedom from subaortic reintervention overall was 92.3% and 88.5% at 5 and 12 years, respectively, much greater with CS than with SS (HR, 4.91; P  < .0001). The independent risk factors for reintervention were younger age at the index procedure (HR, 0.1/y; P  = .002), concomitant MV procedure (HR, 2.68; P  = .019), ventricular septal defect plus interrupted aortic arch (HR, 3.19; P  = .014), and ventricular septal defect plus aortic coarctation (HR, 2.41; P  = .023). Undergoing a concomitant aortic valve procedure at the index procedure was protective (HR, 0.29; P  = .025). Conclusions Patients with SS had excellent outcomes. However, those with CS had worse long-term survival and freedom from reintervention, with morbidity and mortality greatest in young patients with multiple lesions. Additional evaluation in large-scale prospective studies is warranted.