Aortic stenosis of the neonate: A single-center experience

Vergnat, Mathieu; Asfour, Boulos; Arenz, Claudia; Suchowerskyj, Philipp; Bierbach, Benjamin; Schindler, Ehrenfried; Schneider, Martin; Hraška, Viktor

doi:10.1016/j.jtcvs.2018.08.089

Cited by 46 publications

(54 citation statements)

References 26 publications

(48 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the current literature, a longer freedom from reintervention is generally reported after surgical valvotomy than after balloon valvotomy, with freedom from reintervention at 10 years after surgical valvotomy of between 35 and 68%. 5,8,14,15,17 This was confirmed in a recent publication by Vergnat et al 18 In our study, statistical comparison between surgical and balloon valvotomy is not fruitful, as only six patients had a primary balloon valvotomy.…”

Section: Discussionsupporting

confidence: 76%

A national study of the outcome after treatment of critical aortic stenosis in the neonate

et al. 2020

View full text Add to dashboard Cite

Objective: This study describes short-term and long-term outcome after treatment of critical valvular aortic stenosis in neonates in a national cohort, with surgical valvotomy as first choice intervention. Methods: All neonates in Sweden treated for critical aortic stenosis between 1994 and 2016 were included. Patient files were analysed and cross-checked against the Swedish National Population Registry as of December 2017, giving complete survival data. Diagnosis was confirmed by reviewing echo studies. Critical aortic stenosis was defined as valvular stenosis with duct-dependent systemic circulation or depressed left ventricular function. Primary outcome was all-cause mortality and secondary outcomes were reintervention and aortic valve replacement. Results: Sixty-one patients were identified (50 boys, 11 girls). Primary treatment was surgical valvotomy in 52 neonates and balloon valvotomy in 6. Median age at initial treatment was 5 days (0–26), and median follow-up time was 10.8 years (0.14–22.6). There was no 30-day mortality but four late deaths. Freedom from reintervention was 66%, 61%, 54%, 49%, and 46% at 1, 5, 10, 15, and 20 years, respectively. Median time to reintervention was 3.4 months (4 days to 17.3 years). Valve replacement was performed in 23 patients (38%). Conclusions: Surgical valvotomy is a safe and reliable treatment in these critically ill neonates, with no 30-day mortality and long-term survival of 93% in this national study. At 10 years of age, reintervention was performed in 54% and at end of follow-up 38% had had an aortic valve replacement.

show abstract

Section: Discussionsupporting

confidence: 76%

A national study of the outcome after treatment of critical aortic stenosis in the neonate

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In young infants, Vergnat et al 4 reported SAVachieved better results, while ours, excluding neonates, was comparable. Small anulus and extremely fused valve made it hard to identify and repair the valve by surgery.…”

Section: Discussionsupporting

confidence: 46%

Surgical and Transcatheter Treatments in Children with Congenital Aortic Stenosis

Zhu

Wen

et al. 2020

Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Background For patients with congenital aortic valve stenosis (AVS), comprehensive analysis of surgical aortic valvuloplasty (SAV) or balloon dilation (BD) is scarce and remains controversial. Methods This study reviewed AVS data (aortic peak gradient, aortic insufficiency, and survival and reoperation) for patients who were suitable for biventricular repair at our center in 2008 to 2018. Patients were categorized into two subgroups based on age (≤3 or >3 months). Results A total of 194 patients were treated, including 124 with SAV and 70 with BD. Resulting data revealed that residual aortic gradient at discharge was worse for BD (p = 0.001). While for patients younger than 3 months, the relief of AVS was comparable between the two groups (p = 0.624). There was no significant difference in time-related survival between the two groups (log-rank p = 0.644). Multivariate analysis demonstrated that preoperative left ventricular end-diastolic dimension predicted early death (p = 0.045). Survival in the two groups after 10 years was 96.8% in SAV and 95.7% in BD (p = 0.644). Freedom from reoperation after 10 years was 58.1% in SAV and 41.8% in BD patients (p = 0.01). There was no significant difference in freedom from reoperation between SAV and BD in patients younger than 3 months (p = 0.84). Multivariate analysis indicated that residual aortic peak gradient was predictive of reoperation (p = 0.038). Conclusion Both methods achieved excellent survival outcomes at our center. SAV achieved superior gradient reduction and minimized the necessity for reoperation. For patients younger than 3 months, BD rivaled SAV both in aortic stenosis relief and freedom from reoperation.

show abstract

“…In the neonate with ductal-dependent systemic circulation, the key issue is to decide whether left-sided structures are adequate to sustain the systemic circulation, and if so, what kind of treatment is the most beneficial [15,16]. Various predictive formulas [17,18] have been proposed and are often calculated, but minor changes in measurements can result in opposite recommendations, the algorithms can conflict with each other, and there is no consensus on what is definitively required to establish a successful biventricular correction [16].…”

Section: Decision-making Critical Aortic Stenosismentioning

confidence: 99%

“…Neonatal Critical Aortic Stenosis Surgical Management: Open Valvotomy Open valvotomy has been advocated by several recent publications [15,[22][23][24][25][26] as it allows construction of a cusp anatomy that is as close as possible to the normal anatomy. Shaving of thickened cusps, excision of obstructive myxomatous nodularities, and mobilization of the cusps effectively increase the orifice area of the valve in any type of morphology, with a minimal risk of creating regurgitation (Fig.…”

Section: Surgical and Interventional Managementmentioning

confidence: 99%