[II-IPD-02] Surgical valvotomy for aortic stenosis in small children
Previous reports showed advantage and disadvantage between surgical valvotomy and catheter valvotomy but still in debate. Our institutional preference for the treatment of aortic stenosis in neonates or infants is surgical valvotomy to achieve sufficient relief of stenosis, incorporating valvotomy and resection of myxomatous nodule. We report our long-term outcomes after surgical valvotomy. From 1994 to 2019, 25 patients underwent surgical valvotomy. Median age and body weight at surgery were 24 days and 3.5kg, respectively. Morphology of aortic valve was bicuspid in 14 patients, monocuspid in 6 patients, and tricuspid in 5 patients. Cardiopulmonary bypass time and aortic cross clamp time were 77.7±27.0 min and 43.3±17.6min, respectively. There was no hospital death and 2 patients required ECMO support. After surgery, peak pressure gradient across the aortic valve was decreased from 80.0±27.3 to 35.3±12.0mmHg. At median follow-up period of 9.4 years, there was 1 late death and 6 patients required reinterventions, including 5 surgical and 1 catheter valvotomy. Freedom from death at 15 years was 95.2%. Freedom from reintervention at 5 and 10 years were 85.4% and 66.4%, respectively. Echocardiogram at follow-up showed that peak pressure gradient across aortic valve was 39.6±16.0mmHg and only 1 patient had greater than moderate aortic regurgitation. Risk factor analysis showed premature birth and bicuspid aortic valve as risk for reinterventions. Our surgical outcome for aortic stenosis was satisfactory and can delay Ross operation or aortic valve replacement beyond childhood.