Document Detail


Midterm outcomes in supravalvular aortic stenosis demonstrate the superiority of multisinus aortoplasty.
MedLine Citation:
PMID:  20417748     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Surgical techniques for repair of supravalvular aortic stenosis (SVAS) include McGoon's one-patch, Doty's two-patch, and Brom's three-patch method. In this review we evaluated mid-term clinical outcomes of these techniques at our institution. METHODS: Our cardiac surgery database identified patients with SVAS repair from 1990 to 2008. Follow-up records, reintervention and reoperation data, and most recent echocardiograms were obtained. RESULTS: From 1990 to 2008, 20 patients (70% male) underwent surgery for SVAS. Mean age was 3.6 +/- 5.6 years. In chronological sequence, 8 patients had single-patch aortoplasty, 4 had the Doty procedure, and 8 received Brom's symmetric three-patch aortoplasty. Of the Brom patients, 6 had Williams syndrome. Aortic cross-clamp times were 40.1 +/- 13.6 minutes (one-patch), 60.3 +/- 38.8 minutes (Doty), and 104 +/- 20.5 minutes (Brom). Perioperative mortality was 5.0% (1 patient in one-patch group). Mean postoperative length of stay was 10 +/- 10.6 days. Follow-up data were available for all survivors (mean follow-up, 6.3 +/- 6.0 years; range, 6 months to 16 years). There were no late deaths. Follow-up echocardiograms revealed a peak Doppler gradient across the aortic outflow tract of 33 +/- 18.0 mm Hg (one-patch), 10 +/- 1 mm Hg (Doty), and 18 +/- 12 mm Hg (Brom). All patients in the Doty and Brom groups had less than moderate aortic insufficiency. Reoperations were required in 5 of 8 one-patch patients (62%) for residual aortic stenosis (n = 3), aortic insufficiency (n = 1), and subvalvar stenosis (n = 1). No Doty or Brom patient has required aortic reoperations, which was nearly statistically associated with freedom from reoperation (p = 0.06). Subvalvar stenosis was the only risk factor associated with reoperation (p = 0.0028). CONCLUSIONS: Despite a longer cross-clamp time, SVAS repair by Doty or Brom aortoplasty restores normal hemodynamics and reduces the need for reoperation when compared with the classic one-patch technique. Our current preference for SVAS repair is the Brom three-patch symmetric aortoplasty.
Authors:
Sunjay Kaushal; Carl Lewis Backer; Shivani Patel; Jeffrey G Gossett; Constantine Mavroudis
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-26     Completed Date:  2010-06-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1371-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60614, USA. skaushal@childrensmemorial.org
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MeSH Terms
Descriptor/Qualifier:
Aorta, Thoracic / surgery
Aortic Stenosis, Supravalvular / congenital,  mortality,  surgery*
Cardiac Surgical Procedures / methods
Child
Child, Preschool
Databases, Factual
Female
Follow-Up Studies
Humans
Kaplan-Meiers Estimate
Length of Stay
Male
Postoperative Complications / mortality,  physiopathology
Probability
Prostheses and Implants
Prosthesis Implantation / methods
Reconstructive Surgical Procedures / methods*,  mortality
Retrospective Studies
Risk Assessment
Survival Rate
Time Factors
Vascular Surgical Procedures / methods*,  mortality
Williams Syndrome / mortality,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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