Predictors of operative mortality in critical valvular aortic stenosis presenting in infancy.
Congenital aortic stenosis presenting within the first 6 months of life is a highly lethal anomaly. Although aortic valvotomy has offered excellent palliation in many instances, the operative risk remains substantial. To better understand the factors associated with a poor operative result, the records of all patients less than 6 months of age undergoing aortic valvotomy at our institution from 1972 through 1986 were analyzed. Nineteen patients (58%) (Group I) survived operation; 14 (42%) (Group II) died. The following variables were analyzed in an attempt to define those with prognostic significance: mean pulmonary artery pressure (PAP), left ventricular (LV) peak systolic pressure, LV end-diastolic pressure, peak systolic aortic valve gradient, LV end-diastolic volume (LVEDV), LV ejection fraction, and age at operation. The only variables that were significantly different in the two groups were mean PA (Group I, 29 +/- 3 mm Hg, and Group II, 54 +/- 3 mm Hg; p less than 0.001) and LVEDV (Group I, 50 +/- 8 ml/m2, and Group II, 20 +/- 4 ml/m2; p less than 0.05). No patient with an LVEDV of 20 ml/m2 or less survived operation. We conclude that small LV dimension and elevation of PAP may be predictive of a poor surgical result in patients with severe aortic stenosis presenting in infancy.
Hammon
J W
JW
Department of Cardiac and Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Lupinetti
F M
FM
Maples
M D
MD
Merrill
W H
WH
First
W H
WH
Graham
T P
TP
Bender
H W
HW
D000206:Actuarial Analysis; D001024:Aortic Valve Stenosis / Q000151:congenital / Q000401:mortality / Q000601:surgery*; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D013318:Stroke Volume; D013514:Surgical Procedures, Operative / Q000401:mortality*