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Ann Thorac Surg 1990;50:69-73
© 1990 The Society of Thoracic Surgeons

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Articles

Late results of aortic valvotomy for congenital valvar aortic stenosis

Surgery Branch and Cardiology Branch, National Heart, Lung and Blood institute, National Institutes of Health, Bethesda, Maryland USA

Accepted for publication January 26, 1990.

^_* Address reprint requests to Dr Clark, Surgery Branch, NHLBI, NEH, Blood 10. Room 2N244, Bethesda, MD 20892.

Fifty-one patients, aged 1 to 18 years, having aortic valvotomy for congenital valvar aortic stenosis between 1956 and 1986 were followed up. The average age at operation was 11.5 years, with an operative mortality of 3.9%. The aortic valve gradient decreased from a mean preoperative value of 91 mm Hg to 27 mm Hg postoperatively. Current follow-up was 90% and averaged 16.8 years. Late cardiac mortality was 17.6%, with actuarial survival of 93.7% at 10 and 15 years, 81.8% at 20 and 25 years, and 70.9% at 28 years. Nineteen patients required reoperation (39%) at a mean of 17.7 years postoperatively, with a reoperation-free survival of 98% at 10 years. The reoperation rate accelerated in the following decade to 3.3% per year. Ten patients without reoperation were evaluated by continuous-wave Doppler echocardiography. The mean gradient was 21.6 mm Hg, and 90% had mild to moderate aortic insufficiency. This study confirms the efficacy of valvotomy in this age group and suggests that long-term survival and time to reoperation may be longer than previously reported.

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