title: Extended single-patch repair of supravalvar aortic stenosis: a simple and effective technique.
abstract: BACKGROUND
  The optimal surgical procedure for repair of supravalvar aortic stenosis (SVAS) remains uncertain. Proponents of multisinus repair techniques suggest improved outcomes compared with the single-patch technique. We evaluated the outcomes after an extended single-patch technique for relief of SVAS.
  
  
  METHODS
  A cross-sectional retrospective analysis was performed of all SVAS patients who underwent repair from 1996 to 2009. Patient, procedural, and hospital course data were obtained through a review of the medical records. At follow-up, patients were evaluated for residual SVAS gradient, valvar aortic stenosis, aortic insufficiency, and need for reintervention.
  
  
  RESULTS
  Twenty-two patients (mean age, 2.4 ± 2.4 years) underwent repair of SVAS (discrete form, 59%). Mean preoperative peak gradient was 77 ± 27 mm Hg (range, 20 to 139 mm Hg). There were no hospital deaths. Median postoperative length of stay was 5 days (range, 3 to 68 days). Mean follow-up was 4.1 ± 3.5 years (range, 0.7 to 13 years). Follow-up Doppler echocardiography revealed a peak left ventricular outflow tract gradient of 10 ± 12 mm Hg (range, 0 to 41 mm Hg). No patient had significant valvar aortic stenosis or insufficiency. Two patients (9%) required catheter-based reintervention that was unrelated to the SVAS repair.
  
  
  CONCLUSIONS
  This study demonstrates that a simple, extended single-patch technique for repair of SVAS provides excellent medium-term results. A durable reduction in gradient with low complication and recurrence rates can be achieved without the need for more complicated multisinus patch repairs.
authors.affiliation: Department of Surgery, Section of Cardiac Surgery, Division of Pediatric Cardiovascular Surgery, University of Michigan Medical School, Ann Arbor, Michigan 48109-5864, USA.
authors.forename: Minoo N
authors.initials: MN
authors.lastname: Kavarana
authors.forename: Meghan
authors.initials: M
authors.lastname: Riley
authors.forename: Vikram
authors.initials: V
authors.lastname: Sood
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ohye
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Devaney
authors.forename: Edward L
authors.initials: EL
authors.lastname: Bove
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hirsch
mesh_terms: D001011:Aorta / Q000601:surgery; D021921:Aortic Stenosis, Supravalvular / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome