title: Surgical management of left ventricular outflow tract obstruction.
abstract: BACKGROUND
  Left ventricular outflow tract obstruction (LVOTO) is caused by a spectrum of lesions. This study was performed to determine the outcomes of surgical management of LVOTO.
  
  
  METHODS
  All patients who had surgery of the LVOT between 2002 and 2010 were retrospectively reviewed.
  
  
  RESULTS
  There were 103 consecutive patients with median age 6.8 years (range 8 days to 62 years). Fourteen patients had simple subaortic membrane. Eighty-nine patients had complex LVOTO including fibromuscular obstruction (n = 53), tunnel obstruction (n = 22), hypertrophic cardiomyopathy/muscular obstruction (n = 15), and anomalies of the mitral subvalvar apparatus (n = 13). There were no early deaths. Mean LVOT gradient decreased from 33 mmHg (range 1 to 108 mmHg) to 6 mmHg (range 0 to 45 mmHg) (p < 0.001). Median follow-up was 3.8 years (range 0.9 to 8.5 years). There were three late deaths. Cumulative survival at one, three, and five years was 96% (95% CI 89% to 99%). All patients are in New York Heart Association classes I-II. Ten patients required reoperation (three for recurrent/residual LVOTO). Freedom from reoperation was 94%, 90%, and 78% at one, three, and five years (95% CI 86% to 98%, 80% to 95%, and 59% to 89%, respectively). No patient with complex LVOTO who had release of the fibrous trigones required reoperation [0% (0/26) vs. 16% (10/63) (p = 0.031)]. Factors associated with increased reoperation risk were interrupted aortic arch (OR 6.4, p = 0.22), atrioventricular septal defect (OR 15.4, p = 0.008), and higher mean LVOT gradient at discharge (OR 1.08, p = 0.023).
  
  
  CONCLUSIONS
  Utilizing a multitude of operative strategies for surgery of the LVOT results in favorable early and midterm outcomes. Residual LVOTO and original cardiac diagnosis are associated with increased reoperation risk. Release of the fibrous trigones decreases reoperation risk in patients with complex LVOTO.
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, California, USA.
authors.forename: Petros V
authors.initials: PV
authors.lastname: Anagnostopoulos
authors.forename: Natalie C
authors.initials: NC
authors.lastname: Johnson
authors.forename: Laura
authors.initials: L
authors.lastname: Robertson
authors.forename: Anil
authors.initials: A
authors.lastname: Sapru
authors.forename: Anthony
authors.initials: A
authors.lastname: Azakie
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D056346:Sternotomy; D016019:Survival Analysis; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000401:mortality / Q000601:surgery*; D055815:Young Adult