Surgical Outcome of Discrete Subaortic Stenosis in Adults

• DOI: 10.1161/circulationaha.112.000883
• Publication Date: 2013-02-21T07:03:39Z
• Authors: Denise van der Linde; Jolien W. Roos-He...; Dimitris Rizopoulos; Helena J. Heuvelman; Werner Budts; Arie P.J. van Dijk; Maarten Witsenburg; Sing C. Yap; Angela Oxenius; Candice K. Silver...; Erwin N. Oechslin; Ad J.J.C. Bogers; Johanna J.M. Takk...
• Keywords: Ventricular outflow tract; Septal myectomy

Discrete subaortic stenosis is notable for its unpredictable hemodynamic progression in childhood and high reoperation rate; however, data about adulthood are scarce.Adult patients who previously underwent surgery discrete were included this retrospective multicenter cohort study. Mixed-effects joint models used to assess the postoperative of aortic regurgitation, as well reoperation. A total 313 at 4 centers (age baseline, 20.2 years [25th-75th percentile, 18.4-31.0 years]; 52% male). Median follow-up duration was 12.9 (25th-75th 6.2-20.1 years), yielding 5617 patient-years. The peak instantaneous left ventricular outflow tract gradient decreased from 75.7±28.0 mm Hg preoperatively 15.1±14.1 postoperatively (P<0.001) thereafter increased over time a rate 1.31±0.16 Hg/y (P=0.001). Mild regurgitation present 68% but generally did not progress (P=0.76). preoperative ≥80 predictor moderate postoperatively. Eighty required least 1 (1.8% per patient-year). Predictors female sex (hazard ratio, 1.53; 95% confidence interval, 1.02-2.30) 1.45; 1.31-1.62). Additional myectomy reduce risk (P=0.92) significantly complete heart block requiring pacemaker implantation (8.1% versus 1.7%; P=0.005).Survival excellent after stenosis; recurrent uncommon. Over time, slowly increases mild common, although nonprogressive time. Myectomy does show additional advantages, because it associated with an block, should be performed routinely.