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Surgery for simple and complex subaortic stenosis in children and young adults: results from a prospective, procedure-based national database
- Source :
- The Journal of thoracic and cardiovascular surgery. 148(6)
- Publication Year :
- 2014
-
Abstract
- Objective To identify the outcomes of surgically treated subaortic stenosis in a national population. Methods From 2000 to 2013, 1047 patients aged < 40 years underwent 1142 subaortic stenosis procedures. Of the 1047 patients, 484 (46.2%) were considered to have complex stenosis (CS) because at or before the first operation they had mitral valve (MV) disease, aortic valve disease, aortic coarctation or an interrupted aortic arch. Results The 30-day mortality was 0.7% for simple stenosis (SS), 2.3% for CS (P = .06), and 1.6% overall. Age < 1 year (P < .01), MV procedure (P = .02) and an interrupted aortic arch at the index procedure (P < .01) were risk factors for early death. Konno-type procedure early mortality was 2.4%. The 12-year survival was 97.1%, with a significant difference between SS and CS (hazard ratio [HR], 4.53; P = .02). Having MV disease alone (HR, 4.11; P = .02), MV disease plus aortic coarctation (HR, 6.73; P = .008), and age < 1 year (HR, 6.72; P < .001) were risk factors for late mortality. Freedom from subaortic reintervention overall was 92.3% and 88.5% at 5 and 12 years, respectively, much greater with CS than with SS (HR, 4.91; P < .0001). The independent risk factors for reintervention were younger age at the index procedure (HR, 0.1/y; P = .002), concomitant MV procedure (HR, 2.68; P = .019), ventricular septal defect plus interrupted aortic arch (HR, 3.19; P = .014), and ventricular septal defect plus aortic coarctation (HR, 2.41; P = .023). Undergoing a concomitant aortic valve procedure at the index procedure was protective (HR, 0.29; P = .025). Conclusions Patients with SS had excellent outcomes. However, those with CS had worse long-term survival and freedom from reintervention, with morbidity and mortality greatest in young patients with multiple lesions. Additional evaluation in large-scale prospective studies is warranted.
- Subjects :
- Aortic valve
SEPTAL-DEFECT
Cardiac & Cardiovascular Systems
Time Factors
Databases, Factual
Respiratory System
Kaplan-Meier Estimate
Postoperative Complications
Risk Factors
Mitral valve
Medicine
Hospital Mortality
Prospective cohort study
Child
1102 Cardiorespiratory Medicine and Haematology
education.field_of_study
OUTCOMES
Interrupted aortic arch
Hazard ratio
Age Factors
medicine.anatomical_structure
Treatment Outcome
Child, Preschool
Cardiology
Cardiology and Cardiovascular Medicine
Life Sciences & Biomedicine
Pulmonary and Respiratory Medicine
Adult
Reoperation
medicine.medical_specialty
Adolescent
Population
VENTRICULAR OUTFLOW TRACT
Young Adult
Internal medicine
Humans
Cardiac Surgical Procedures
education
AORTIC-STENOSIS
Proportional Hazards Models
Retrospective Studies
REPAIR
Science & Technology
business.industry
Infant, Newborn
Infant
1103 Clinical Sciences
medicine.disease
Aortic Stenosis, Subvalvular
United Kingdom
Surgery
Stenosis
Concomitant
Cardiovascular System & Cardiology
RISK-FACTORS
EXPERIENCE
OBSTRUCTION
business
Subjects
Details
- ISSN :
- 1097685X
- Volume :
- 148
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Accession number :
- edsair.doi.dedup.....fd64be34ef42248567d46c0c6a1003c5