The Studies Of Treatment Of Congenital Aortic Valve Stenosis

Objective:Congenital aortic stenosis(AS)is a common congenital heart disease.Treatment of aortic disease include surgical aortic valvuloplasty(SAV)and transcatheter balloon aortic valvuloplasty(BAV).None-critical AS could achieve receptable results.The majority of them would suffer from repeating interventions for the rest of their life.While both methods as a palliation would end up with receiving Ross procedure or mechanical valve replacement for critical AS.The first part of this study explored the experience of surgical repair of aortic stenosis in Shanghai Children’s Medical Center,and analyzed the outcomes of transcatheter and surgical treatments of non-critical AS in Part Two,aiming to provide reference for clinical diagnosis and treatment of AS.Methods:We retrospectively analyzed the clinical data of children diagnosed with isolated AS with or without aortic insufficient(underwent aortic repair from January2008 to December 2018).And patients suffering from aortic stenosis who underwent biventricular correction(including surgical aortic valvuloplasty and balloon aortic valvuloplasty)from 2008 to December 2018 were reviewed.Preoperative data,shortterm and long-term valve function,mortality and long-term survival and freedom from aortic valve reoperation were recorded and analyzed.Results:The mean age of the 148 patients receiving surgical valve repair was 4.5±3.9years,and 112 patients had aortic stenosis,36 had stenosis together with regurgitation.There were 87 cases of commissurotomy,39 cases of complicated valvuloplasty and 22 cases of aortic valve replacement.In 29 cases,extra pericardium patch was used to repair the valve.Survival at 10 year was 95.1%,and freedom from reoperation was65.2%.A total of 194 patients were treated,including 124 with SAV and 70 with BAV.Resulting data revealed that residual aortic gradient at discharge was worse for BAV(p=0.001).While for patients younger than three months,the relief of AVS was comparable between two groups(p=0.624).There was no significant difference in timerelated survival between the two groups(log-rank p=0.644).Freedom from reoperation at 10 years was 58.1% in SAV and 41.8% in BAV(log-rank p=0.01).Conclusion: Congenital aortic valve repair in children is a safe and effective method that provides enough time to achieve a more definitive solution.Surgical strategies should be tailored to the patient’s age.Intraoperative use of the patch increases the risk of reoperation.Regardless of the transcatheter or surgical treatment,postoperative survival was satisfactory.Surgical treatment achieved better reduction of aortic stenosis with a lower reoperation rate without increasing any regurgitation.While BAV rivalled SAV in patients younger than 3 months.