title: Long-term outcome of congenital aortic valve stenosis: predictors of reintervention.
abstract: OBJECTIVE
  To evaluate long-term outcome of initial aortic valve intervention in a paediatric population with congenital aortic stenosis, and to determine risk factors associated with reintervention.
  
  
  METHODS
  From 1985 to 2009, 77 patients with congenital aortic stenosis and a mean age of 5.8±5.6 years at diagnosis were followed up in our institution for 14.8±9.1 years.
  
  
  RESULTS
  First intervention was successful with 86% of patients having a residual peak aortic gradient 1 regurgitation increased by 7%. Long-term survival after the first procedure was excellent, with 91% survival at 25 years. At a mean interval of 7.6±5.3 years, 30 patients required a reintervention (39%), mainly because of a recurrent aortic stenosis. Freedom from reintervention was 97, 89, 75, 53, and 42% at 1, 10, 15, 20, and 25 years, respectively. Predictors of reintervention were residual peak aortic gradient (p=0.0001), aortic regurgitation post-intervention >1 (p=0.02), prior balloon aortic valvuloplasty (p=0.04), and increased left ventricular posterior wall thickness (p=0.1).
  
  
  CONCLUSIONS
  Aortic valve intervention is a safe and effective procedure for congenital aortic stenosis with excellent survival results. However, rate of reintervention is high and influenced by increased left ventricular posterior wall thickness pre-intervention, prior balloon valvuloplasty, higher residual peak systolic valve gradient, and more than mild regurgitation post-intervention. The study highlights that long-term follow-up is recommended for these patients.
authors: 1Department of Cardiovascular Surgery,University Hospital,Lausanne,Switzerland.
authors: Léa
authors: L
authors: Hochstrasser
authors: 1Department of Cardiovascular Surgery,University Hospital,Lausanne,Switzerland.
authors: Patrick
authors: P
authors: Ruchat
authors: 2Pediatric Cardiology Unit,University Hospital,Lausanne,Switzerland.
authors: Nicole
authors: N
authors: Sekarski
authors: 1Department of Cardiovascular Surgery,University Hospital,Lausanne,Switzerland.
authors: Michel
authors: M
authors: Hurni
authors: 1Department of Cardiovascular Surgery,University Hospital,Lausanne,Switzerland.
authors: Ludwig K
authors: LK
authors: von Segesser
mesh_terms: D001024:Aortic Valve Stenosis / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery*; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Congenital aortic valve stenosis; balloon valvuloplasty; predictors of reintervention; surgical valvotomy