LATE OUTCOME OF SURVIVORS OF INTERVENTION FOR NEONATAL AORTIC-VALVE STENOSIS

Background. This study examined the late outcome after intervention fo r neonatal aortic valve stenosis. Methods. Seventy-three neonates (59 boys and 14 girls) underwent intervention for critical aortic valve st enosis during the first 30 days of life at two institutions, The Hospi tal for Sick Children, London, and Duke University Medical Center, Dur ham, North Carolina. Procedures performed include closed valvotomy (n = 12), open valvotomy with inflow occlusion (n = 14), open valvotomy w ith cardiopulmonary bypass (n = 33), balloon valvotomy (n = 12), and o ther procedures (n = 2). The mean age at the first intervention was 8 +/- 1 days. Results. The hospital mortality was 52.1%. The mean durati on of follow-up for the hospital survivors (n = 35) was 8.3 +/- 1.1 ye ars. The actuarial survival for the hospital survivors was 93.3% +/- 4 .7% at 10 years and 83.9% +/- 9.8% at 15 years, whereas event-free sur vival (reintervention, endocarditis, or early death) was 61.8% +/- 9.3 % at 5 years, 34.2% +/- 10.8% at 10 years, and 27.4% +/- 10.6% at 15 y ears. Three patients have died and 11 patients have required aortic va lve replacement during the follow-up period. The age at the initial in tervention, the type of initial intervention, and the year of initial intervention were not predictive of early death or need for reinterven tion. At last follow-up, 26 of the long-term survivors (n = 32) were i n functional class I and 6 were in functional class II. Conclusions. A ortic stenosis in the neonatal period is a difficult problem with a hi gh initial mortality. Late survival and functional class are excellent for patients surviving the initial hospitalization, but most require further intervention within 10 years.