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%.
Cohort (n=85)
No
What are the risk factors for reintervention after surgical repair of paediatric subaortic stenosis?
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.
Hazard Ratio: 7.46 (95% CI 2.48–22.49)
Absolute Event Rate: 83% vs 18%
p-value: p=<0.001
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.
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%.