title: Midterm outcomes in supravalvular aortic stenosis demonstrate the superiority of multisinus aortoplasty.
abstract: BACKGROUND
  Surgical techniques for repair of supravalvular aortic stenosis (SVAS) include McGoon's one-patch, Doty's two-patch, and Brom's three-patch method. In this review we evaluated mid-term clinical outcomes of these techniques at our institution.
  
  
  METHODS
  Our cardiac surgery database identified patients with SVAS repair from 1990 to 2008. Follow-up records, reintervention and reoperation data, and most recent echocardiograms were obtained.
  
  
  RESULTS
  From 1990 to 2008, 20 patients (70% male) underwent surgery for SVAS. Mean age was 3.6 +/- 5.6 years. In chronological sequence, 8 patients had single-patch aortoplasty, 4 had the Doty procedure, and 8 received Brom's symmetric three-patch aortoplasty. Of the Brom patients, 6 had Williams syndrome. Aortic cross-clamp times were 40.1 +/- 13.6 minutes (one-patch), 60.3 +/- 38.8 minutes (Doty), and 104 +/- 20.5 minutes (Brom). Perioperative mortality was 5.0% (1 patient in one-patch group). Mean postoperative length of stay was 10 +/- 10.6 days. Follow-up data were available for all survivors (mean follow-up, 6.3 +/- 6.0 years; range, 6 months to 16 years). There were no late deaths. Follow-up echocardiograms revealed a peak Doppler gradient across the aortic outflow tract of 33 +/- 18.0 mm Hg (one-patch), 10 +/- 1 mm Hg (Doty), and 18 +/- 12 mm Hg (Brom). All patients in the Doty and Brom groups had less than moderate aortic insufficiency. Reoperations were required in 5 of 8 one-patch patients (62%) for residual aortic stenosis (n = 3), aortic insufficiency (n = 1), and subvalvar stenosis (n = 1). No Doty or Brom patient has required aortic reoperations, which was nearly statistically associated with freedom from reoperation (p = 0.06). Subvalvar stenosis was the only risk factor associated with reoperation (p = 0.0028).
  
  
  CONCLUSIONS
  Despite a longer cross-clamp time, SVAS repair by Doty or Brom aortoplasty restores normal hemodynamics and reduces the need for reoperation when compared with the classic one-patch technique. Our current preference for SVAS repair is the Brom three-patch symmetric aortoplasty.
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60614, USA. skaushal@childrensmemorial.org
authors.forename: Sunjay
authors.initials: S
authors.lastname: Kaushal
authors.forename: Carl Lewis
authors.initials: CL
authors.lastname: Backer
authors.forename: Shivani
authors.initials: S
authors.lastname: Patel
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Gossett
authors.forename: Constantine
authors.initials: C
authors.lastname: Mavroudis
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery; D021921:Aortic Stenosis, Supravalvular / Q000151:congenital / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011336:Probability; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality; D018980:Williams Syndrome / Q000401:mortality / Q000601:surgery*