Abstract
Objective. To analyze the long-term results of surgical treatment of congenital aortic stenosis in infants.
Material and methods. Between 2011 and 2018, 84 surgical procedures for congenital aortic stenosis in patients under 1 year were performed at Federal Center for Cardiovascular Surgery of the Ministry of Healthcare of Russian Federation. There were 2 groups depending on the type of primary intervention. The first group included patients who underwent “open heart” surgery (n=46), the second group – patients after performing transluminal balloon valvuloplasty (n=38). The median age at the time of surgery was 53 days (varying from 1 to 327).
Results. Early postoperative mortality was 3 (3,5%) patients independent of the group. There were no late postoperative mortality. Redo open heart surgery was performed in 8 (9.5%) patients. The actuarial freedom from reoperations in terms of follow up to 7 years for patients of the 1st group was at 86,2% and for patients of second group was 57,8% (p=0.04). The statistically significant influence of the following risk factors on the probability of aortic valve restenosis in the long-term period was revealed: balloon valvuloplasty (odds ratio (OR) 1.87; confidence inteval (CI) 1.11–3.21; p=0.04), the significant systolic pressure gradient on the aortic valve at the time of discharge (OR 1.1; CI 1.02–1.41; p=0.01).
Conclusions. According to the results of this study surgical valvuloplasty with bypass and balloon valvuloplasty are both effective methods for the treatment of aortic stenosis in infants. Endovascular balloon valvuloplasty in children group of under the group age of one year may be used as a destination therapy or as a first stage correction of the defect. High mean peak pressure gradient in the postoperative period increase the risk of reoperations.
References
- Бокерия Л.А., Шаталов К.В. (ред.) Детская кардиохирургия: Руководство для врачей. М.: НЦССХ им. А.Н. Бакулева МЗ РФ; 2016.
- Белозеров Ю.М., Брегель Л.В., Леонтьева И.В., Субботин В.М. Врожденный двухстворчатый аортальный клапан у детей. Ульяновск; 2015.
- Brown J.W., Rodefeld M.D., Ruzmetov M. Surgical valvuloplasty versus balloon aortic dilation for congenital aortic stenosis: are evidence-based outcomes relevant? Ann. Thorac. Surg. 2012; 94: 146–55. DOI: 10.1016/athoracsur. 2012.02.054
- Siddiqui J., Brizard C.P. Surgical valvotomy and repair for neonatal and infant congenital aortic stenosis achieves better results than interventional catheterization. J. Am. Coll. Cardiol.2013; 62 (22): 2134–40. DOI:10.1016/ j.jacc.2013. 07.052
- Зеленикин М.А., Волков С.С. Оправданна ли открытая вальвулопластика при врожденном клапанном стенозе аорты у детей. Детские болезни сердца и сосудов. 2015; 4: 58–60.
- Chernogrivov A., Bofanov D., Chernogrivov I., Sulejmanov S., Rybakova T., Nazarova I., Bazylev V. Open surgery for bicuspid aortic valve in neonates and infants: what should we know about the anatomy? WSPCHS, June 20–22, 2019. Bulgaria, Sofia; 2019.
- Holzer R.J., Cheatham J.P. Shifting the balance between aortic insufficiency and residual gradients after balloon aortic valvuloplasty. J. Am. Coll. Cardiol. 2010; 56 (21): 1750–1. DOI: 10.1016/j.jacc.2010.07.024
- Hraska V., Photiadis J., Arenz C. Open valvotomy for aortic valve stenosis in newborns and infants. Multimed. Man. Cardiothorac. Surg. 2007; 619. DOI: 10.1510/mmcts. 2006.002311
- Komiya T. Aortic valve repair update. Gen. Thorac. Cardiovasc. Surg. 2015; 63 (6): 309–19. DOI: 10.1007/ s11748-015-0523-1
- Lewin M.B., Otto C.M. The bicuspid aortic valve. Adverse outcomes from infancy to old age. Circulation. 2005; 111: 832–4. DOI: 10.1161/01.CIR.0000157137.59691.0B
- Подзолков В.П., Самсонов В.Б., Данилов Т.Ю. Открытая аортальная комиссуротомия как этап хирургического лечения клапанного стеноза аорты у детей. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2017; 18 (6): 10.
- David W.B., Amy E., Dipilato B.S. Aortic valve reinterventions after balloon aortic valvuloplasty for congenital aortic stenosis. J. Am. Coll. Cardiol. 2010; 56 (21): 1740–9. DOI: 10.1016/ j.jacc.2010.06.040
- Bonow R.O., Carabello B., de Leon A.C., Edmunds L.H., Jr., Fedderiy B.J., Freed M.D. Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology. American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Circulation. 2008; 98: 1949–84. DOI: 10.1161/01. cir.98.18.1949
- Han R.K., Gurofsky R.C., Williams W.G., Smallhorn J.F., McCrindle B.W. Outcome and growth potential of left heart structure after neonatal intervention for aortic valve stenosis. J. Am. Coll. Cardiol. 2007; 50: 2406–14. DOI:10.1016/ j.jacc.2007.07.082
- Campbell M. The natural history of congenital aortic stenosis. Br. Heart J. 1968; 30: 514–26. DOI: 10.1136/hrt.30.4.514
- Hoffman J.I., Christianson R. Congenital heart disease in a cohort of 19,502 births with long-term follow-up. Am. J. Cardiol. 1978; 42: 641–7. DOI:10.1016/00029149(78)90635-5
- Lofland G.K., McCrindle B.W., Williams W.G., Blackstone E.H., Tchervenkov C.I., Sittiwankul R., Jonas R.A. Critical aortic stenosis in the neonate: a multi- institutional study of management, outcomes, and risk factors. J. Thorac. Cardiovasc. Surg. 2001; 121: 10–27. DOI: 10.1067/mtc 2001.111207
- Kortz A.B., Swan H. Direct vision trans-aortic approach to the aortic valve duringhypothermia; experimental observations and report of successful clinical case. Ann. Surg. 1956; 144: 205–14. DOI: 10.1097/00000658-195608000-00010
- Spencer F.C., Neill C.A., Sank L., Bahnson H.T. Anatomical variations in 46 patients with congenital aortic stenosis. Am. Surg. 1960; 26: 204–16.
- Caspi J., Ilbawi M.N., Roberson D.A., Piccione W., Jr., Monson D.O., Najafi H. Extended aortic valvuloplasty for recurrent valvular stenosis and regurgitation in children. J. Thorac. Cardiovasc. Surg. 1994; 107 (4): 1114–20.
- Lababidi Z., Wu J.R., Walk J.T. Percutaneous aortic balloon valvuloplasty: results in 23 patients. Am. J. Cardiol. 1984; 53: 194–7. DOI: 10.1016/0002-9149(84)90709-4
- Walls J.T., Lababidi Z., Curtis J.J., Silver D. Assessment of percutaneous balloon pulmonary and aortic valvuloplasty. J. Thorac. Cardiovasc. Surg. 1984; 88: 352–6.
- Zeevi B., Keane J.F., Castaneda A.R., Perry S.B., Lock J.E. Neonatal critical valvar aortic stenosis. A conprarison of surgical and balloon dilation therapy. Circulation. 1989; 80: 831–9. DOI: 10.1161/01.cir.80.4.831
- Базылев В.В., Кобзев Е.Е., Бабуков Р.М., Россейкин Е.В. Операция OZAKI при узком фиброзном кольце аортального клапана – новое решение старой проблемы? Грудная и сердечно-сосудистая хирургия. 2018; 60 (3): 217–55.
- Konstantinov I.E., d'Udekem Y., Brizard C.P. Ross operation or valve repair in neonates and infants? J. Thorac. Cardiovasc. Surg. 2014; 148: 362–3. DOI: 10.1016/j.jtcvs.2014.02.053
About the authors
- Aleksey E. Chernogrivov, Dr. Med. Sc., Head of Department, orcid.org/0000-0002-6207-4799;
- Dmitriy A. Bofanov, Cardiovascular Surgeon, orcid.org/0000-0003-0492-8845;
- Igor‘ E. Chernogrivov, Dr. Med. Sc., Cardiovascular Surgeon, orcid.org/0000-0002-6619-3875;
- Mark G. Shmatkov, Specialist in Endovascular Diagnosis and Treatment, orcid.org/0000-0002-3553-4075;
- Irina S. Nazarova, Pediatric Cardiologist, orcid.org/0000-0003-0090-6948;
- Vladlen V. Bazylev, Dr. Med. Sc., Chief Physician, orcid.org/0000-0001-6089-9722
