Aortic valvotomy for congenital valvular aortic stenosis: A 37-year experience

Background. The purpose of the study was to analyze the long-term results o f aortic valvotomy and the risk factors associated with reoperation and sur vival. Methods. From 1960 to 1977, 116 patients with congenital valvular aortic st enosis underwent isolated aortic valvotomy at a mean age of 13.7 +/- 7.8 ye ars with a mean aortic gradient of 78 +/- 33 mm Hg. Fifteen patients had ad ditional aortic regurgitation, and leaflet calcification was present in ano ther 15 patients. Results. Postoperatively the mean aortic gradient decreased to 19.4 +/- 11. 3 mm Hg (p < 0.0001). Early mortality was 2.6%. At a mean follow-up of 23.8 years, 26 late deaths (22.4%) occurred among the 113 early survivors. Actu arial 10-, 20-, 30-, and 37-year survival rates were 94.6%, 79.7%, 76.2%, a nd 72.5%, respectively. According to multivariate Cox regression analysis, survival was influenced by preoperative New York Heart Association class (p = 0.0418), leaflet calcification (p = 0.0339), date of operation (p = 0.02 53), and postoperative endocarditis (p < 0.0001). At a mean interval of 18. 3 years, 37 patients required reoperation (31.9%) mainly because of recurre nt aortic stenosis. The reoperation rate increased significantly 15 years p ostoperatively from 0.73%/year to 2.31%/ year (p < 0.0001). In a multivaria te risk model, reoperation was influenced by older patient age (p = 0.0032) and the presence of leaflet calcification (p = 0.0289). Conclusions. Aortic valvotomy is a simple and effective procedure for conge nital aortic stenosis with excellent long-term results. However, the rate o f reoperation increases 15 years postoperatively, and clinical follow-up sh ould be intensified. Our results suggest that early repair should be perfor med and that adequate patient selection is the most important determinant o f the longterm results. (Ann Thorac Surg 2001;71:1564-71) (C) 2001 by The S ociety of Thoracic Surgeons.