title: The mid-term outcome of primary open valvotomy for critical aortic stenosis in early infancy - a retrospective single center study over 18 years.
abstract: BACKGROUND
  The objective of this study was to examine early and long-term results of surgical aortic valvotomy in neonates and infants aged less than four months and to identify predictors of outcome.
  
  
  METHODS
  Between August 1994 and April 2012, 83 consecutive patients younger than 4 months of age underwent open heart valvotomy for critical aortic stenosis in our institution. Median age was 17 days (range 0-111 days). We examined clinical records to establish determinants of outcome and illustrate long-term results.
  
  
  RESULTS
  Fifty-six patients (67 %) were neonates. Associated cardiac malformations were found in 24 patients (29 %), including multilevel left heart obstruction in 5. The median follow-up was 4.2 years. The time-related survival rate was 87 and 85 % at 5 and 15 years, respectively. The time-related survival without reintervention was respectively 51, 35 and 18 % at 5, 10 and 15 years. The time-related survival without aortic valve replacement was respectively 67, 54 and 39 % at 5, 10 and 15 years. Ventricular dysfunction (p = 0.04), delayed sternal closure (p = 0.007), endocardial fibroelastosis (p = 0.02) and low z-score of the aortic annulus (p = 0.04) were found predictors of global mortality. Ventricular dysfunction (p = 0.01) and endocardial fibroelastosis (p = 0.04) were found predictors of reintervention.
  
  
  CONCLUSIONS
  The experience, in our center, on the management of critical aortic stenosis, shows a low early and late mortality, but the aortic valvotomy is a palliative procedure and we see unfortunately a high rate of reintervention among which the aortic valve replacement. These results suggest to reconsider the use of aortic balloon valvotomy, and particularly for the neonates with a low cardiac output in order to avoid the myocardial stress and the neurological injury due to the cardiopulmonary bypass.
authors.affiliation: Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Centre Chirurgical Marie-Lannelongue, INSERM U 999, Université Paris-Sud, 133 Avenue Résistance, 92350, Le Plessis Robinson, E.U., France. clairebertail@hotmail.fr.
authors.forename: Claire
authors.initials: C
authors.lastname: Galoin-Bertail
authors.affiliation: Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Centre Chirurgical Marie-Lannelongue, INSERM U 999, Université Paris-Sud, 133 Avenue Résistance, 92350, Le Plessis Robinson, E.U., France.
authors.forename: André
authors.initials: A
authors.lastname: Capderou
authors.affiliation: Institut Hospitalier Jacques Cartier, 6 Avenue du Loyer Lambert, 91300, Massy, E.U., France.
authors.forename: Emre
authors.initials: E
authors.lastname: Belli
authors.affiliation: Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Centre Chirurgical Marie-Lannelongue, INSERM U 999, Université Paris-Sud, 133 Avenue Résistance, 92350, Le Plessis Robinson, E.U., France.
authors.forename: Lucile
authors.initials: L
authors.lastname: Houyel
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome