Long-term results of surgical valvuloplasty for congenital valvar aortic stenosis in children

Background. To question the validity of surgical aortic valvuloplasty for c ongenital aortic valve stenosis, a retrospective study was undertaken to de termine the long-term survival, the incidence of valve restenosis or insuff iciency, and the freedom of reoperation or valve replacement. Methods. From January 1960 through 1992, 67 consecutive children diagnosed with congenital aortic valve stenosis underwent an open aortic valvuloplast y at our institution. Ages at operation ranged from 6 to 228 months (mean 1 05.7 +/- 52 months). The mean follow-up of these patients has been 127.5 +/ - 66.7 months. Results. There was no hospital mortality, but two late valve-related deaths occurred. Eight patients developed aortic regurgitation 5 to 125 months (m ean 66.6 +/- 35 months) after surgical valvuloplasty, and 1 of them require d aortic valve replacement. Because of restenosis, 16 patients required a s econd operation. Of them, 5 children underwent a second aortic valvuloplast y without mortality and, in 4 of them, the functional result has been excel lent after a mean follow-up of 75.4 +/- 12 months. Eleven patients required an aortic valve replacement 62 to 208 months postop (mean 100.9 +/- 50.8 m onths). Mechanical prosthesis were used in 7 and bioprosthesis in 4. Two pa tients required a Konno and 1 required a Ross procedure. There were no earl y nor lab deaths after reoperations. The probability of 20-year survival af ter the first valvuloplasty was 94%, the freedom of reoperation 63%, and th e freedom of aortic valve replacement 73% for the same time period. Conclusions. Our results demonstrate that congenital aortic valvar stenosis in children can be surgically well controlled until adulthood. Our study a lso shows that surgical valvuloplasty is a safe and efficacious procedure a nd that its benefical effect is maintained over 20 years in the majority of children. (C) 1999 by The Society of Thoracic Surgeons.