title: Outcome of surgical correction of congenital supravalvular aortic stenosis with two- and three-sinus reconstruction techniques.
abstract: BACKGROUND
  Several surgical techniques for the treatment of congenital supravalvular aortic stenosis have been developed, yet there is no consensus about the optimal approach. We reviewed our institutional experience with 2- and 3-sinus reconstruction techniques.
  
  
  METHODS
  Thirty-eight patients operated on for supravalvular aortic stenosis between 1987 and 2012 in our institution were analyzed retrospectively. Eight patients (21%) were infants and in 5 (13.2%) diffuse stenosis was present. Mean peak pressure gradient was 86.1±28.7 mm Hg preoperatively. Surgical procedures included single-patch enlargement (McGoon, n=3), inverted bifurcated-patch aortoplasty (Doty, n=22), 3-sinus patch augmentation (Brom, n=8), and autologous slide aortoplasty (n=5). Major concomitant procedures were performed in 10 patients (26.3%).
  
  
  RESULTS
  Early mortality was 2.6%. Follow-up continued for a median of 7.5 years (range 3 weeks to 22 years). Overall survival estimates were 94% and 90% and overall freedom from reoperation was 83% at 5 and 20 years, respectively. No differences were found between surgical techniques in respect to survival, clinical course, hemodynamic outcome, or freedom from reoperation rates. A significantly worse outcome in regard to survival and reoperation rates was observed in infants.
  
  
  CONCLUSIONS
  Our study demonstrates equally good results for the repair of supravalvular aortic stenosis with both 2- and 3-sinus reconstruction. No evidence of a superior outcome for 3-sinus reconstruction techniques was found. Operation in infancy is an important factor associated with unfavorable outcome.
authors.affiliation: Department of Congenital Heart Diseases and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kramer
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Absi
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Photiadis
authors.affiliation: Department of Congenital Heart Diseases and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. Electronic address: alexi@dhzb.de.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Alexi-Meskishvili
mesh_terms: D000293:Adolescent; D000328:Adult; D021921:Aortic Stenosis, Supravalvular / Q000151:congenital* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D055815:Young Adult
keywords: 20