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Ann Thorac Surg 2007;84:594-598
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Outcome of Surgical Commissurotomy for Aortic Valve Stenosis in Early Infancy

^a Pediatric Cardiac Surgical Unit, Children’s Hospital, University Hospital, Lund, Sweden
^b Pediatric Cardiology Unit, Children’s Hospital, University Hospital, Lund, Sweden
^c Pediatric Cardiology Unit, Astrid Lindgren Children’s Hospital, Stockholm, Sweden

Accepted for publication March 29, 2007.

^_* Address correspondence to Dr Malm, Pediatric Cardiac Surgical Unit, University Hospital, Lund, 221 85, Sweden (Email: torsten.malm{at}skane.se).

Background: The method of treatment of aortic valve stenosis in early infancy is still controversial. This study was performed to evaluate short-term and long-term outcome in our center during a 14-year period.

Methods: Between 1991 and 2004, 64 consecutive patients younger than 3 months old underwent open surgical commissurotomy because of aortic valve stenosis. Median age was 18 days (range, 1 to 79 days), and median weight was 3.6 kg (range, 1.9 to 6.7 kg). Left ventricular function was good in 44 patients (69%), depressed in 12 (19%), and poor in 8 (12%). The study ended in July 2005. Median follow-up time was 4.1 years (range, 0.4 to 13.6 years).

Results: The 30-day mortality was 3 of 64 patients and late mortality was 3 of 61, and the respective mortality in patients younger than 1 month old was 2 of 41 and 2 of 39. There was no early mortality after 1993 and no late mortality after 1999. Thirteen patients required reoperation. Median time to reoperation was 4.3 years (range, 0.2 to 11.3 years) and to aortic valve replacement (7 Ross and 1 homograft) was 6.9 years (range, 1.6 to 9.7 years). At the last follow-up, all had good left ventricular function and 57 of 58 had an ability index of 1.

Conclusions: Surgical commissurotomy for aortic valve stenosis during the first 3 months of life can be done with low mortality and morbidity. The risk for early recurrent stenosis or regurgitation is low, and the need for aortic valve replacement can, in most cases, be delayed until the child is older. The long-term functional ability is excellent.