AUTHOR=Schlein Johanna , Wollmann Felix , Kaider Alexandra , Wiedemann Dominik , Gabriel Harald , Hornykewycz Stephan , Base Eva , Michel-Behnke Ina , Laufer Günther , Zimpfer Daniel 

TITLE=Long-term outcomes after surgical repair of subvalvular aortic stenosis in pediatric patients

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1033312

DOI=10.3389/fcvm.2022.1033312

ISSN=2297-055X

ABSTRACT=Objectives
Subvalvular aortic stenosis (SAS) can occur as discrete or tunnel-like obstruction of the left ventricular outflow tract and as progressive disease often lead to aortic valve regurgitation. Long-term outcomes and especially the timing of surgical intervention for SAS remain incompletely defined. We report our 30-year single-center experience after surgical repair of SAS. 

Methods
A retrospective chart review of all patients aged < 18 years, who underwent surgical repair of subvalvular aortic stenosis from May 1985 to April 2020, was conducted. Mortality was cross-checked with the national health insurance database (93.8% complete mortality follow-up in April 2020). Survival and competing risks analysis were used to analyze the primary endpoints survival and incidence of reoperations.  

Results
From May 1985 until April 2020 103 patients (median age 5.5 years) underwent surgical repair of SAS. Survival was 90.8% at 10 years and 88.7% at 20 and 30 years. Age <1 year at time of surgery, Shone’s complex, mitral stenosis and concomitant mitral valve surgery were associated with mortality. The cumulative incidence of reoperation for SAS was 21.6% at 10 years, 28.2% at 20 and 30 years. The incidence of reoperation for SAS did not differ between the myectomy, membrane resection and combined myectomy and membrane resection groups. The cumulative incidence of reoperation on the aortic valve was 13.5% at 20 years.

Conclusion
Recurrence rate of subaortic stenosis is not to be neglected, though surgical repair of subaortic stenosis has good long-term results.