Twenty years experience of surgical aortic valvotomy for critical aortic stenosis in early infancy

To examine early and long-term results of surgical aortic valvotomy in neonates and infants aged less than 3 months. A review of all 34 neonates (n=26) and young infants (n=8) aged 1-62 days undergoing primary open valvotomy for aortic valve stenosis between 1983 and 2003 was carried out. Associated major cardiac anomalies were endocardial fibroelastasis (n=8), aortic coarctation (n=3), subvalvular aortic stenosis (n=2), and ventricular septal defect (n=1). Risk factors for early mortality were estimated. Current information was available for 31 patients for a follow-up of 115+/-67 months. Kaplan-Meier method was used to estimate freedom from reintervention. Two neonates died early: operative mortality of 6% (2/34). Risk factors for early mortality were associated endocardial fibroelastosis, monocuspid aortic valve and impaired left ventricular function. No patient died late. Seven patients needed reintervention for re-aortic stenosis (n=5) or aortic insufficiency (n=2), i.e., re-valvotomy (n=3), valve replacement (n=2), Ross procedure (n=1), and balloon valvuloplasty (n=1). Freedom from reintervention was 85.1+/-6.9%, 78.0+/-9.35%, and 53.5+/-15.9% at 5, 10, and 15 years, respectively. Primary surgical aortic valvotomy in early infancy carries a low early and late mortality, a low occurrence of significant aortic regurgitation and a low early recurrence of aortic stenosis. In great majority of cases, reintervention can be delayed to allow implantation of an adult-sized prosthesis, when required.