Key result
Critical valvular aortic stenosis in neonates was associated with significantly lower event-free survival compared to non-critical stenosis (40% vs 67%, p=0.002) over a median 13.5 years.
Why the study?
The study was conducted to compare long-term survival, reinterventions, and risk factors using strict definitions of neonatal critical and non-critical valvular aortic stenosis.
Do long-term survival and reintervention rates differ between neonates with critical versus non-critical valvular aortic stenosis?
Cohort (n=107)
Yes
Do long-term survival and reintervention rates differ between neonates with critical versus non-critical valvular aortic stenosis?
Neonates with critical aortic stenosis have a significantly higher need for early reintervention and lower long-term event-free survival compared to those with non-critical stenosis, despite similar overall long-term survival.
Supports risk-stratified surveillance in critical neonatal aortic stenosis; leaves open optimal intervention timing in prospective studies.
OBJECTIVE: To compare long-term survival, reinterventions and risk factors using strict definitions of neonatal critical and non-critical valvular aortic stenosis (VAS). DESIGN: A nationwide retrospective study using data from patient files, echocardiograms and the Swedish National Population Registry. SETTING AND PATIENTS: All neonates in Sweden treated for isolated VAS 1994-2018. We applied the following criteria for critical aortic stenosis: valvular stenosis with duct-dependent systemic circulation or depressed left ventricular function (fractional shortening ≤27%). Indication for treatment of non-critical VAS was Doppler mean gradient >50 mm Hg. MAIN OUTCOME MEASURES: Short-term and long-term survival, aortic valve reinterventions need of valve replacements, risk factors for reintervention and event-free survival. RESULTS: We identified 65 patients with critical VAS and 42 with non-critical VAS. The majority of the neonates were managed by surgical valvotomy. Median follow-up time was 13.5 years, with no patients lost to follow-up. There was no 30-day mortality. Long-term transplant-free survival was 91% in the critical stenosis group and 98% in the non-critical stenosis group (p=0.134). Event-free survival was 40% versus 67% (p=0.002) in the respective groups. Median time from the initial treatment to reintervention was 3.6 months versus 3.9 years, respectively (p=0.008). CONCLUSIONS: Critical VAS patients had significantly higher need for reintervention during the first year of life, lower event-free survival and lower freedom from aortic valve replacement at age ≥18 years, compared with neonates with non-critical stenosis.
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Olofsson et al. (2023) conducted a cohort in Valvular aortic stenosis (n=107). Critical valvular aortic stenosis vs. Non-critical valvular aortic stenosis was evaluated on Event-free survival (p=0.002). Critical valvular aortic stenosis in neonates was associated with significantly lower event-free survival compared to non-critical stenosis (40% vs 67%, p=0.002) over a median 13.5 years.
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