What is the clinical evidence from this study?

Study design: Cohort. Population: Discrete (or membranous) subaortic stenosis (DSAS) (n=105). Intervention: Blunt dissection vs. Sharp excision. Primary outcome: Reoperation for recurring or persisting DSAS.

January 1, 1993

Surgery for membranous subaortic stenosis *1Long-term follow-up

Key Result

Blunt dissection for discrete subaortic stenosis resulted in a lower incidence of reoperation (2.1%) compared to sharp excision (27.6%).

Study Design

Type

Cohort (n=105)

Structured PICO

Does blunt dissection reduce the incidence of reoperation compared to sharp excision in patients with discrete subaortic stenosis?

Population

105 patients operated for discrete subaortic stenosis between 1958 and 1992, followed long-term to compare sharp excision versus blunt dissection.

Exposure

Blunt dissection to enucleate DSAS completely (n=47, performed after 1980)

Comparator

Sharp excision leaving the part on the mitral valve untouched (n=58, performed before 1980)

Outcome

Reoperation due to recurring or persisting DSAShard clinical

Blunt enucleation of discrete subaortic stenosis is safe and associated with a lower rate of reoperation compared to sharp excision.

Main Result

Absolute Event Rate: 2.1% vs 27.6%

Limitations

Follow-up is shorter for the blunt enucleation group

Abstract

From 1958 to 1992, 105 patients were operated for discrete (or membranous) subaortic stenosis (DSAS). Our surgical techniques changed during this period. Before 1980 DSAS was removed by a sharp excision leaving the part on the mitral valve untouched (n = 58). After 1980 blunt dissection was used to enucleate DSAS completely (n = 47). The operation for DSAS was combined with aortic valve replacement (AVR) in 7 instances. Follow-up with recent echo-Doppler studies was complete in 100 patients. Recurring or persisting DSAS led to reoperation in 17 patients. Sixteen of them had had sharp, incomplete resections. One patient from the group of complete blunt enucleations was reoperated on twice. The interval between the first operation and the first reoperation averaged 9.7 years (range: 1-33 years). Nine reoperated patients had AVR. The risk factors for AVR were older age at first operation or late reoperation. In our early experience five patients died after operation. Another three patients died following one or more reoperations. Blunt dissection never led to complete AV block. It follows the anatomical cleavage planes and always allowed for complete and safe removal of DSAS. Although the follow-up is shorter, blunt enucleation thus far has had a lower incidence of reoperation.

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