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J Thorac Cardiovasc Surg 1999;118:874-885
© 1999 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

FORTY-ONE YEARS OF SURGICAL EXPERIENCE WITH CONGENITAL SUPRAVALVULAR AORTIC STENOSIS

From the Departments of Cardiac Surgery^a and Biostatistics,^b Children’s Hospital Boston, Harvard Medical School, Boston, Mass.
*The American Association for Thoracic Surgery Evarts A. Graham Fellow 1998-1999.

Address for reprints: Pedro J. del Nido, MD, Children’s Hospital Boston, Department of Cardiac Surgery, 300 Longwood Ave, Boston, MA 02115 (Email: delnido{at}a1.tch.harvard.edu).

Objective: Several techniques for symmetric reconstruction of the aortic root in congenital supravalvular aortic stenosis have been developed, but it remains unclear whether these prove superior to patch enlargement of the noncoronary sinus alone. We reviewed our experience with surgical treatment of supravalvular aortic stenosis and investigated the impact of the surgical technique on long-term results.
Methods and results: Seventy-five patients underwent operations to treat congenital supravalvular aortic stenosis at our institution between 1957 and 1998. Surgical procedures included patch enlargement of the noncoronary sinus only (n = 34), inverted bifurcated patch plasty (n = 35), and 3-sinus reconstruction of the aortic root (n = 6). There were 7 early deaths. Among those who survived the operation, 100% were alive at 5 years, 96% were alive at 10 years, and 77% were alive at 20 years. According to time-related analysis diffuse stenosis of the ascending aorta proved a risk factor for both survival and reoperation (P < .01 for each). Patients with multiple-sinus reconstructions of the aortic root accounted for only 2 of the 14 reoperations and none of the late deaths (both P < .001). Residual gradients were lower after multiple-sinus reconstruction of the aortic root (median 10 mm Hg vs 20 mm Hg for patch enlargement of the noncoronary sinus only, P = .008), as was the prevalence of moderate aortic regurgitation at follow-up (3% vs 22%, P = .05).
Conclusions: Results of operations for supravalvular aortic stenosis improved greatly after the introduction of more symmetric reconstructions of the aortic root. Multiple-sinus reconstructions (inverted bifurcated patch plasty and 3-sinus reconstruction) resulted in superior hemodynamics and were associated with reductions in both mortality rate and need for reoperation.

During the time of this investigation Dr C. Stamm was supported by a grant from the German Research Foundation (STA 497/2-2).

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