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.
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Figure 1 Scatterplot of Highest Preoperative Peak LVOT Doppler Gradient Versus Year of Operation
Note the lack of a significant change over time that would suggest a systematic evolution in criteria for referral to surgery based on pressure gradient. LVOT = left ventricular outflow tract.
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Figure 2 Kaplan-Meier Survival Curve for the Study Cohort
The solid line indicates overall probability of being free from reoperation versus time. Dashed lines indicate the 95% confidence interval.
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Figure 3 Kaplan-Meier Survival Curves Separating Patients by Independent Predictors of Reoperation
(A) Patients in whom the distance in systole between the discrete subaortic stenosis (DSS) and the aortic valve (AoV) was <6 mm were significantly more likely to require reoperation than those with longer distances between the obstruction and the valve. (B) Patients with peak preoperative pressure gradients across the left ventricular outflow tract  60 mm Hg were significantly more likely to require reoperation than those with less severe gradients.
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Figure 4 Peak Gradient as a Function of Age in Patients With First Surgery Before and After 4 Years of Age
Points represent median peak gradient at initial diagnosis, preoperative echocardiogram, early postoperative echocardiogram, and latest follow-up plotted against median age at these events. Error bars represent the interquartile range around median peak gradients at each time point. Note that patients who were operated on earlier (blue) began with a lower peak gradient that rose more rapidly to a value equal to that in patients with a later age at operation (red), suggesting a more rapidly progressing pathology.
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