CLINICAL RESEARCH: CONGENITAL HEART DISEASE
Risk Factors for Reoperation After Repair of Discrete Subaortic Stenosis in Children
Alon Geva, AB*,2,
Colin J. McMahon, MB*,1,2,
Kimberlee Gauvreau, ScD*,
Laila Mohammed, RDCS*,
Pedro J. del Nido, MD and
Tal Geva, MD*,*
* Department of Cardiology, Children’s Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
Department of Cardiovascular Surgery, Children’s Hospital Boston, and Department of Surgery, Harvard Medical School, Boston, Massachusetts.
Manuscript received March 7, 2007;
revised manuscript received May 30, 2007,
accepted July 1, 2007.
* Reprint requests and correspondence: Dr. Tal Geva, Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, Massachusetts 02115. (Email: tal.geva{at}cardio.chboston.org).
Objectives: This study aimed to identify independent predictors of reoperation after successful resection of discrete subaortic stenosis (DSS).
Background: Recurrence of DSS has been reported to range from 0% to 55% of patients. Factors associated with recurrence have not been adequately defined.
Methods: Patients were included if they had a diagnosis of DSS, normal segmental cardiac anatomy, previous resection of DSS, and at least 36 months’ follow-up. Demographic, surgical, and echocardiographic data were analyzed. Primary outcome was repeat resection of DSS in patients after successful primary resection.
Results: Of 111 subjects who had successful surgical resection of DSS, 16 patients (14%) required reoperation. Median follow-up time was 8.2 years. Form of DSS and gender did not differ significantly between those with reoperation and those without. In multivariate analysis, independent predictors of reoperation that would be available before first surgery were <6 mm distance between the aortic valve (AoV) and the obstruction (hazard ratio [HR] 5.1; p = 0.013) and peak gradient by Doppler  60 mm Hg (HR 4.2; p = 0.016). If intraoperative variables are also considered, peeling of the membrane from the AoV or mitral valve at first surgery, <6 mm distance between the DSS and AoV, and peak gradient by Doppler 60 mm Hg were independent predictors of reoperation.
Conclusions: Proximity of the obstructive lesion to the AoV and severe obstruction determined by preoperative echocardiography, as well as involvement of valve leaflets requiring surgical peeling, predict recurrent DSS requiring reoperation.
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Abbreviations and Acronyms
| | AoV = aortic valve | | AR = aortic regurgitation | | AV = atrioventricular | | DSS = discrete subaortic stenosis | | FMR = fibromuscular ridge | | LVOT = left ventricular outflow tract | | MV = mitral valve |
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