Critical aortic stenosis (AS) in neonates necessitates urgent intervention for patient survival. The optimal treatment, however, continues to be controversial and has still high morbidity and mortality. This study examined our late outcome after treatment of critical AS in neonates.
Fifty-two neonates (34 boys and 18 girls) underwent closed transventricular aortic valvotomy for critical AS between 1985 and 2000. The mean age at the first intervention was 9.0 ± 10.2 days (ranges from 1 to 30 days). 17 patients (Group I) had isolated critical AS and normal or dilated left ventricles. The Group II comprises 35 neonates (67%) who had associated cardiovascular anomalies (i.e. aortic annular hypoplasia, hypoplasia of the left ventricle (LV), mitral valve anomalities, endocardial fibroelastosis, and/or ductus dependant).
The hospital mortality was 17.3% (9/52). All nonsurvival patients were in group 2. 15-year survival was 100% in group 1 and 71.4% in group 2. At last follow-up (mean 7.8 ± 3.1 years), 36 of the survivors were in functional class I and 6 were in class II. Multi logistic regression showed that of the eight factors deemed significant on univariate analysis, only three risk factors remained significant on multivariate analysis; (1) presence of hypoplastic of LV (p=0.001), (2) low LV ejection fraction (EF; p=0.002), and (3) low LV end-diastolic volume (p=0.001). 15-year freedom from any reoperation in group 1 was 53.6% and 68% in group 2. In the Cox univariate analysis the best preoperative predictors of late reoperation were aortic valve annulus of less than 5.0 mm (p=0.004), and low LVEF (p=0.02).CONCLUSIONS: We conclude critical AS in neonates continues to carry a significant mortality. Surgical and balloon valvotomy are both palliative procedures and reinterventions are usually required within 10 years of initial treatment.
M. Ruzmetov, None.