Open commissurotomy for critical isolated aortic stenisis in neonates

Christos Alexiou, Stephen M. Langley, Malcolm J R Dalrymple-Hay, Anthony P. Salmon, Barry R. Keeton, Marcus P. Haw, James L. Monro

Research output: Contribution to journalArticle

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Abstract

Background. The optimal management of critical aortic stenosis in early infancy remains controversial. The aim of this study was to assess the early and late outcomes following open surgical valvotomy for critical aortic stenosis in neonates and to provide a framework of data against which current results of other treatment approaches can be evaluated. Methods. Eighteen consecutive neonates (mean age 9.2 days, range 1 to 26 days) undergoing an open valvotomy for critical isolated aortic stenosis (the standard treatment for this condition in our unit) between 1984 and 2000 were studied. The mean aortic valve gradient was 79.4 mm Hg. Twelve neonates received prostaglandins and 10 received inotropic agents preoperatively. Follow-up was complete (mean 8.1 years, range 1 month to 15 years). Results. There was no operative mortality. At discharge, the mean aortic valve gradient was 37.2 mm Hg, with 6 patients having mild and 2 having moderate aortic regurgitation. Six patients required a reoperation; 3 of these had an aortic valve replacement at 9 to 11 years of age. Kaplan-Meier 5- and 10-year freedoms from any aortic reoperation or reintervention were 85 and 55%, respectively; 5- and 10-year freedoms from aortic valve replacement were 100 and 79%, respectively. A 14-year old boy died from endocarditis 4 years following an aortic valve replacement in another unit. Kaplan-Meier 10-year survival was 100%. All survivors are in New York Heart Association I class and are leading normal lives. Their mean aortic valve gradient is 34.5 mm Hg, and none has significant aortic regurgitation. Conclusions. Open valvotomy for critical aortic stenosis in neonates carries a low operative risk and provides lengthy freedom from recurrent stenosis or regurgitation. Reoperations are inevitable, but aortic valve replacement can be delayed until the implantation of an adult-sized prosthesis is possible. Late survival is excellent. We consider open surgical valvotomy to be the treatment of choice for critical neonatal aortic stenosis.

Original languageEnglish (US)
Pages (from-to)489-493
Number of pages5
JournalAnnals of Thoracic Surgery
Volume71
Issue number2
DOIs
StatePublished - 2001
Externally publishedYes

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Aortic Valve
Aortic Valve Stenosis
Newborn Infant
Reoperation
Aortic Valve Insufficiency
Survival
Endocarditis
Prostheses and Implants
Prostaglandins
Survivors
Pathologic Constriction
Therapeutics
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Alexiou, C., Langley, S. M., Dalrymple-Hay, M. J. R., Salmon, A. P., Keeton, B. R., Haw, M. P., & Monro, J. L. (2001). Open commissurotomy for critical isolated aortic stenisis in neonates. Annals of Thoracic Surgery, 71(2), 489-493. https://doi.org/10.1016/S0003-4975(00)02232-3

Open commissurotomy for critical isolated aortic stenisis in neonates. / Alexiou, Christos; Langley, Stephen M.; Dalrymple-Hay, Malcolm J R; Salmon, Anthony P.; Keeton, Barry R.; Haw, Marcus P.; Monro, James L.

In: Annals of Thoracic Surgery, Vol. 71, No. 2, 2001, p. 489-493.

Research output: Contribution to journalArticle

Alexiou, C, Langley, SM, Dalrymple-Hay, MJR, Salmon, AP, Keeton, BR, Haw, MP & Monro, JL 2001, 'Open commissurotomy for critical isolated aortic stenisis in neonates', Annals of Thoracic Surgery, vol. 71, no. 2, pp. 489-493. https://doi.org/10.1016/S0003-4975(00)02232-3
Alexiou C, Langley SM, Dalrymple-Hay MJR, Salmon AP, Keeton BR, Haw MP et al. Open commissurotomy for critical isolated aortic stenisis in neonates. Annals of Thoracic Surgery. 2001;71(2):489-493. https://doi.org/10.1016/S0003-4975(00)02232-3
Alexiou, Christos ; Langley, Stephen M. ; Dalrymple-Hay, Malcolm J R ; Salmon, Anthony P. ; Keeton, Barry R. ; Haw, Marcus P. ; Monro, James L. / Open commissurotomy for critical isolated aortic stenisis in neonates. In: Annals of Thoracic Surgery. 2001 ; Vol. 71, No. 2. pp. 489-493.
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abstract = "Background. The optimal management of critical aortic stenosis in early infancy remains controversial. The aim of this study was to assess the early and late outcomes following open surgical valvotomy for critical aortic stenosis in neonates and to provide a framework of data against which current results of other treatment approaches can be evaluated. Methods. Eighteen consecutive neonates (mean age 9.2 days, range 1 to 26 days) undergoing an open valvotomy for critical isolated aortic stenosis (the standard treatment for this condition in our unit) between 1984 and 2000 were studied. The mean aortic valve gradient was 79.4 mm Hg. Twelve neonates received prostaglandins and 10 received inotropic agents preoperatively. Follow-up was complete (mean 8.1 years, range 1 month to 15 years). Results. There was no operative mortality. At discharge, the mean aortic valve gradient was 37.2 mm Hg, with 6 patients having mild and 2 having moderate aortic regurgitation. Six patients required a reoperation; 3 of these had an aortic valve replacement at 9 to 11 years of age. Kaplan-Meier 5- and 10-year freedoms from any aortic reoperation or reintervention were 85 and 55{\%}, respectively; 5- and 10-year freedoms from aortic valve replacement were 100 and 79{\%}, respectively. A 14-year old boy died from endocarditis 4 years following an aortic valve replacement in another unit. Kaplan-Meier 10-year survival was 100{\%}. All survivors are in New York Heart Association I class and are leading normal lives. Their mean aortic valve gradient is 34.5 mm Hg, and none has significant aortic regurgitation. Conclusions. Open valvotomy for critical aortic stenosis in neonates carries a low operative risk and provides lengthy freedom from recurrent stenosis or regurgitation. Reoperations are inevitable, but aortic valve replacement can be delayed until the implantation of an adult-sized prosthesis is possible. Late survival is excellent. We consider open surgical valvotomy to be the treatment of choice for critical neonatal aortic stenosis.",
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AU - Alexiou, Christos

AU - Langley, Stephen M.

AU - Dalrymple-Hay, Malcolm J R

AU - Salmon, Anthony P.

AU - Keeton, Barry R.

AU - Haw, Marcus P.

AU - Monro, James L.

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N2 - Background. The optimal management of critical aortic stenosis in early infancy remains controversial. The aim of this study was to assess the early and late outcomes following open surgical valvotomy for critical aortic stenosis in neonates and to provide a framework of data against which current results of other treatment approaches can be evaluated. Methods. Eighteen consecutive neonates (mean age 9.2 days, range 1 to 26 days) undergoing an open valvotomy for critical isolated aortic stenosis (the standard treatment for this condition in our unit) between 1984 and 2000 were studied. The mean aortic valve gradient was 79.4 mm Hg. Twelve neonates received prostaglandins and 10 received inotropic agents preoperatively. Follow-up was complete (mean 8.1 years, range 1 month to 15 years). Results. There was no operative mortality. At discharge, the mean aortic valve gradient was 37.2 mm Hg, with 6 patients having mild and 2 having moderate aortic regurgitation. Six patients required a reoperation; 3 of these had an aortic valve replacement at 9 to 11 years of age. Kaplan-Meier 5- and 10-year freedoms from any aortic reoperation or reintervention were 85 and 55%, respectively; 5- and 10-year freedoms from aortic valve replacement were 100 and 79%, respectively. A 14-year old boy died from endocarditis 4 years following an aortic valve replacement in another unit. Kaplan-Meier 10-year survival was 100%. All survivors are in New York Heart Association I class and are leading normal lives. Their mean aortic valve gradient is 34.5 mm Hg, and none has significant aortic regurgitation. Conclusions. Open valvotomy for critical aortic stenosis in neonates carries a low operative risk and provides lengthy freedom from recurrent stenosis or regurgitation. Reoperations are inevitable, but aortic valve replacement can be delayed until the implantation of an adult-sized prosthesis is possible. Late survival is excellent. We consider open surgical valvotomy to be the treatment of choice for critical neonatal aortic stenosis.

AB - Background. The optimal management of critical aortic stenosis in early infancy remains controversial. The aim of this study was to assess the early and late outcomes following open surgical valvotomy for critical aortic stenosis in neonates and to provide a framework of data against which current results of other treatment approaches can be evaluated. Methods. Eighteen consecutive neonates (mean age 9.2 days, range 1 to 26 days) undergoing an open valvotomy for critical isolated aortic stenosis (the standard treatment for this condition in our unit) between 1984 and 2000 were studied. The mean aortic valve gradient was 79.4 mm Hg. Twelve neonates received prostaglandins and 10 received inotropic agents preoperatively. Follow-up was complete (mean 8.1 years, range 1 month to 15 years). Results. There was no operative mortality. At discharge, the mean aortic valve gradient was 37.2 mm Hg, with 6 patients having mild and 2 having moderate aortic regurgitation. Six patients required a reoperation; 3 of these had an aortic valve replacement at 9 to 11 years of age. Kaplan-Meier 5- and 10-year freedoms from any aortic reoperation or reintervention were 85 and 55%, respectively; 5- and 10-year freedoms from aortic valve replacement were 100 and 79%, respectively. A 14-year old boy died from endocarditis 4 years following an aortic valve replacement in another unit. Kaplan-Meier 10-year survival was 100%. All survivors are in New York Heart Association I class and are leading normal lives. Their mean aortic valve gradient is 34.5 mm Hg, and none has significant aortic regurgitation. Conclusions. Open valvotomy for critical aortic stenosis in neonates carries a low operative risk and provides lengthy freedom from recurrent stenosis or regurgitation. Reoperations are inevitable, but aortic valve replacement can be delayed until the implantation of an adult-sized prosthesis is possible. Late survival is excellent. We consider open surgical valvotomy to be the treatment of choice for critical neonatal aortic stenosis.

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