What is the clinical evidence from this study?

Study design: Cohort. Population: Paediatric subaortic stenosis (n=85). Intervention: Tunnel-type subaortic stenosis vs. Discrete subaortic stenosis. Primary outcome: Reintervention (HR 7.46, 95% CI 2.48-22.49, p=<0.001).

April 7, 2021Open Access

Paediatric subaortic stenosis: long-term outcome and risk factors for reoperation

Q: What are the key findings of this study?

Tunnel-type subaortic stenosis significantly increased the risk of reintervention compared to discrete subaortic stenosis (HR 7.46), with freedom from reoperation at 10 years dropping to 17% versus 82%.

RWRik De WolfLeiden University Medical Center KFKatrien FrançoisGhent University Hospital TBThierry BovéGhent University Hospital

Key Result

Tunnel-type subaortic stenosis significantly increased the risk of reintervention compared to discrete subaortic stenosis (HR 7.46), with freedom from reoperation at 10 years dropping to 17% versus 82%.

Study Design

Type

Cohort (n=85)

Multicenter

Structured PICO

What are the risk factors for reintervention after surgical repair of paediatric subaortic stenosis?

Population

85 children with paediatric subaortic stenosis, median age 2.5 years, followed for a median of 10.1 years to assess long-term outcomes and risk factors for reoperation.

Exposure

Surgical repair of subaortic stenosis (performed in 83%, n=71)

Outcome

Reintervention/reoperationhard clinical

In children with subaortic stenosis, age <2 years at intervention, postoperative gradient >20 mmHg, tunnel-type morphology, and hypoplastic aortic annulus are independent risk factors for reintervention.

Main Result

Hazard Ratio: 7.46 (95% CI 2.48–22.49)

Absolute Event Rate: 83% vs 18%

p-value: p=<0.001

Limitations

Retrospective nature
Single-centre experience with a relatively small sample size
Small number of patients in the tunnel-type subgroup (n=9)
Lack of uniform definition for complex SAS
Subjective choice for some procedures like the addition of a septal myectomy
Potential selection bias as non-operated patients might not be fully captured in the database

Abstract

OBJECTIVES: Surgical repair of subaortic stenosis (SAS) is associated with a substantial reoperation risk. We aimed to identify risk factors for reintervention in relation to discrete and tunnel-type SAS morphology. METHODS: Single-centre retrospective study of paediatric SAS diagnosed between 1992 and 2017. Multivariable Cox regression analysis was performed to identify reintervention risk factors. RESULTS: Eighty-five children median age 2.5 (0.7-6.5) years at diagnosis with a median follow-up of 10.1 (5.5-16.4) years were included. Surgery was executed in 83% (n = 71). Freedom from reoperation was 88 ± 5% at 5 years and 82 ± 6% at 10 years for discrete SAS, compared to, respectively, 33 ± 16% and 17 ± 14% for tunnel-type SAS (log-rank P 20 mmHg hazard ratio (HR) 6.56, 95% confidence interval (CI) 1.41-24.1; P = 0.005, tunnel-type SAS (HR 7.46, 95% CI 2.48-22.49; P 20 mmHg and presence of a hypoplastic aortic annulus are independent risk factors for reintervention. More extensive LVOT surgery might be considered at an earlier stage in these children. SAS presenting in older children with a low LVOT gradient at diagnosis shows little progression, justifying an expectative approach.

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Cite This Study

Wolf et al. (Wed,) conducted a cohort in Paediatric subaortic stenosis (n=85). Tunnel-type subaortic stenosis vs. Discrete subaortic stenosis was evaluated on Reintervention (HR 7.46, 95% CI 2.48-22.49, p=<0.001). Tunnel-type subaortic stenosis significantly increased the risk of reintervention compared to discrete subaortic stenosis (HR 7.46), with freedom from reoperation at 10 years dropping to 17% versus 82%.

synapsesocial.com/papers/6a45ad666f4bbfd563da3174 https://doi.org/https://doi.org/10.1093/icvts/ivab121

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