Long-term results after valvotomy for congenital aortic valvar stenosis inchildren

As interest increase in the Ross procedure performed as a therapeutic optio n for children with congenital aortic valvar stenosis, it becomes increasin ly important to know the late results of aortic valvotomy in this populatio n. We have therefore examined retrospectively the medical records of 121 co nsecutives survivors undergoing aortic valvotomy before 10 years of age bet ween 1974 and 1992. The mean age at the first valvotomy was 29 months, with a range from 3 days to 10 years. The mean duration of follow up was 9.4 ye ars, with a range from 1.6 to 22 years. Fifteen patients (12.3%; 70% CL: 10 -16) died: 9 following reoperation, and 6 late after surgery. Death was rel ated to the hearts in 86% of cases. The actuarial survival rate was 79% (70 % CL: 72/84) at 10 years. Young age at the first valvotomy, and the number of procedures, emerged as risk factors of secondary mortality. Reoperations on the aortic valve, 73 in all, were required in 56 patients. The second p rocedure was done after a mean interval of 6 years, with a rangefrom 1 day to 18 years. This was for restenosis in three-quarters of the cases. The ao rtic valve was replaced in 30 patients, at a mean of 3 years, and with a ra nge from 9 months to 18 years, after the first procedure. The survival with out replacement at 20 years was 29% (70% CL: 15-49). No factor was identifi ed with a relationship either to reoperation or valvar replacement. Long te rm results after aortic valvotomy, therefore, show a high late mortality fr equent reinterventions, and an almost inescapable eventual need for valvar replacement. The ongoing use of the Ross operation is justified, even if lo ngterm studies in children are still needed to validate its use.