title: Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children.
abstract: OBJECTIVE
  To characterise long-term outcomes after discrete subaortic stenosis (DSS) resection and to identify risk factors for reoperation and aortic regurgitation (AR) requiring repair or replacement.
  
  
  METHODS
  All patients who underwent DSS resection between 1984 and 2009 at our institution with at least 36 months' follow-up were included. Demographic, surgical and echocardiographic data were reviewed. Outcomes were reoperation for recurrent DSS, surgery for AR, death and morbidities, including heart transplant, endocarditis and complete heart block.
  
  
  RESULTS
  Median length of postoperative follow-up was 10.9 years (3-27.2 years). Reoperation occurred in 32 patients (21%) and plateaued 10 years after initial resection. Survival at 10 years and 20 years was 98.6% and 86.3%, respectively. Aortic valve (AoV) repair or replacement for predominant AR occurred in 31 patients (20%) during or after DSS resection. By multivariable analysis, prior aortic stenosis (AS) intervention (HR 22.4, p<0.001) was strongly associated with AoV repair or replacement. Risk factors for reoperation by multivariable analysis included younger age at resection (HR 1.24, p=0.003), preoperative gradient ≥60 mm Hg (HR 2.23, p=0.04), peeling of membrane off AoV or mitral valve (HR 2.52, p=0.01), distance of membrane to AoV <7.0 mm (HR 4.03, p=0.03) and AS (HR 2.58, p=0.01).
  
  
  CONCLUSIONS
  In this cohort, the incidence of reoperations after initial DSS resection plateaued after 10 years. Despite a significant rate of reoperation, overall survival was good. Concomitant congenital AS and its associated interventions significantly increased the risk of AR requiring surgical intervention.
authors.affiliation: Departments of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA Departments of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Pickard
authors.affiliation: Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts, USA Department of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Alon
authors.initials: A
authors.lastname: Geva
authors.affiliation: Departments of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA Departments of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.affiliation: Cardiovascular Surgery, Boston Children's Hospital, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: del Nido
authors.affiliation: Departments of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA Departments of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Tal
authors.initials: T
authors.lastname: Geva
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D001900:Boston; D002648:Child; D002675:Child, Preschool; D021922:Discrete Subaortic Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult