Midterm Outcomes in Supravalvular Aortic Stenosis Demonstrate the Superiority of Multisinus Aortoplasty

Sunjay Kaushal*, Carl L Backer, Shivani Patel, Jeffrey G Gossett, Constantine Mavroudis

*Corresponding author for this work

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Surgical techniques for repair of supravalvular aortic stenosis (SVAS) include McGoon's one-patch, Doty's two-patch, and Brom's three-patch method. In this review we evaluated mid-term clinical outcomes of these techniques at our institution. Methods: Our cardiac surgery database identified patients with SVAS repair from 1990 to 2008. Follow-up records, reintervention and reoperation data, and most recent echocardiograms were obtained. Results: From 1990 to 2008, 20 patients (70% male) underwent surgery for SVAS. Mean age was 3.6 ± 5.6 years. In chronological sequence, 8 patients had single-patch aortoplasty, 4 had the Doty procedure, and 8 received Brom's symmetric three-patch aortoplasty. Of the Brom patients, 6 had Williams syndrome. Aortic cross-clamp times were 40.1 ± 13.6 minutes (one-patch), 60.3 ± 38.8 minutes (Doty), and 104 ± 20.5 minutes (Brom). Perioperative mortality was 5.0% (1 patient in one-patch group). Mean postoperative length of stay was 10 ± 10.6 days. Follow-up data were available for all survivors (mean follow-up, 6.3 ± 6.0 years; range, 6 months to 16 years). There were no late deaths. Follow-up echocardiograms revealed a peak Doppler gradient across the aortic outflow tract of 33 ± 18.0 mm Hg (one-patch), 10 ± 1 mm Hg (Doty), and 18 ± 12 mm Hg (Brom). All patients in the Doty and Brom groups had less than moderate aortic insufficiency. Reoperations were required in 5 of 8 one-patch patients (62%) for residual aortic stenosis (n = 3), aortic insufficiency (n = 1), and subvalvar stenosis (n = 1). No Doty or Brom patient has required aortic reoperations, which was nearly statistically associated with freedom from reoperation (p = 0.06). Subvalvar stenosis was the only risk factor associated with reoperation (p = 0.0028). Conclusions: Despite a longer cross-clamp time, SVAS repair by Doty or Brom aortoplasty restores normal hemodynamics and reduces the need for reoperation when compared with the classic one-patch technique. Our current preference for SVAS repair is the Brom three-patch symmetric aortoplasty.

Original languageEnglish (US)
Pages (from-to)1371-1377
Number of pages7
JournalAnnals of Thoracic Surgery
Volume89
Issue number5
DOIs
StatePublished - May 1 2010

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Supravalvular Aortic Stenosis
Reoperation
Pathologic Constriction
Williams Syndrome
Aortic Valve Stenosis
Thoracic Surgery
Survivors
Length of Stay
Hemodynamics
Databases

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Kaushal, Sunjay ; Backer, Carl L ; Patel, Shivani ; Gossett, Jeffrey G ; Mavroudis, Constantine. / Midterm Outcomes in Supravalvular Aortic Stenosis Demonstrate the Superiority of Multisinus Aortoplasty. In: Annals of Thoracic Surgery. 2010 ; Vol. 89, No. 5. pp. 1371-1377.
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title = "Midterm Outcomes in Supravalvular Aortic Stenosis Demonstrate the Superiority of Multisinus Aortoplasty",
abstract = "Background: Surgical techniques for repair of supravalvular aortic stenosis (SVAS) include McGoon's one-patch, Doty's two-patch, and Brom's three-patch method. In this review we evaluated mid-term clinical outcomes of these techniques at our institution. Methods: Our cardiac surgery database identified patients with SVAS repair from 1990 to 2008. Follow-up records, reintervention and reoperation data, and most recent echocardiograms were obtained. Results: From 1990 to 2008, 20 patients (70{\%} male) underwent surgery for SVAS. Mean age was 3.6 ± 5.6 years. In chronological sequence, 8 patients had single-patch aortoplasty, 4 had the Doty procedure, and 8 received Brom's symmetric three-patch aortoplasty. Of the Brom patients, 6 had Williams syndrome. Aortic cross-clamp times were 40.1 ± 13.6 minutes (one-patch), 60.3 ± 38.8 minutes (Doty), and 104 ± 20.5 minutes (Brom). Perioperative mortality was 5.0{\%} (1 patient in one-patch group). Mean postoperative length of stay was 10 ± 10.6 days. Follow-up data were available for all survivors (mean follow-up, 6.3 ± 6.0 years; range, 6 months to 16 years). There were no late deaths. Follow-up echocardiograms revealed a peak Doppler gradient across the aortic outflow tract of 33 ± 18.0 mm Hg (one-patch), 10 ± 1 mm Hg (Doty), and 18 ± 12 mm Hg (Brom). All patients in the Doty and Brom groups had less than moderate aortic insufficiency. Reoperations were required in 5 of 8 one-patch patients (62{\%}) for residual aortic stenosis (n = 3), aortic insufficiency (n = 1), and subvalvar stenosis (n = 1). No Doty or Brom patient has required aortic reoperations, which was nearly statistically associated with freedom from reoperation (p = 0.06). Subvalvar stenosis was the only risk factor associated with reoperation (p = 0.0028). Conclusions: Despite a longer cross-clamp time, SVAS repair by Doty or Brom aortoplasty restores normal hemodynamics and reduces the need for reoperation when compared with the classic one-patch technique. Our current preference for SVAS repair is the Brom three-patch symmetric aortoplasty.",
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Midterm Outcomes in Supravalvular Aortic Stenosis Demonstrate the Superiority of Multisinus Aortoplasty. / Kaushal, Sunjay; Backer, Carl L; Patel, Shivani; Gossett, Jeffrey G; Mavroudis, Constantine.

In: Annals of Thoracic Surgery, Vol. 89, No. 5, 01.05.2010, p. 1371-1377.

Research output: Contribution to journalArticle

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T1 - Midterm Outcomes in Supravalvular Aortic Stenosis Demonstrate the Superiority of Multisinus Aortoplasty

AU - Kaushal, Sunjay

AU - Backer, Carl L

AU - Patel, Shivani

AU - Gossett, Jeffrey G

AU - Mavroudis, Constantine

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N2 - Background: Surgical techniques for repair of supravalvular aortic stenosis (SVAS) include McGoon's one-patch, Doty's two-patch, and Brom's three-patch method. In this review we evaluated mid-term clinical outcomes of these techniques at our institution. Methods: Our cardiac surgery database identified patients with SVAS repair from 1990 to 2008. Follow-up records, reintervention and reoperation data, and most recent echocardiograms were obtained. Results: From 1990 to 2008, 20 patients (70% male) underwent surgery for SVAS. Mean age was 3.6 ± 5.6 years. In chronological sequence, 8 patients had single-patch aortoplasty, 4 had the Doty procedure, and 8 received Brom's symmetric three-patch aortoplasty. Of the Brom patients, 6 had Williams syndrome. Aortic cross-clamp times were 40.1 ± 13.6 minutes (one-patch), 60.3 ± 38.8 minutes (Doty), and 104 ± 20.5 minutes (Brom). Perioperative mortality was 5.0% (1 patient in one-patch group). Mean postoperative length of stay was 10 ± 10.6 days. Follow-up data were available for all survivors (mean follow-up, 6.3 ± 6.0 years; range, 6 months to 16 years). There were no late deaths. Follow-up echocardiograms revealed a peak Doppler gradient across the aortic outflow tract of 33 ± 18.0 mm Hg (one-patch), 10 ± 1 mm Hg (Doty), and 18 ± 12 mm Hg (Brom). All patients in the Doty and Brom groups had less than moderate aortic insufficiency. Reoperations were required in 5 of 8 one-patch patients (62%) for residual aortic stenosis (n = 3), aortic insufficiency (n = 1), and subvalvar stenosis (n = 1). No Doty or Brom patient has required aortic reoperations, which was nearly statistically associated with freedom from reoperation (p = 0.06). Subvalvar stenosis was the only risk factor associated with reoperation (p = 0.0028). Conclusions: Despite a longer cross-clamp time, SVAS repair by Doty or Brom aortoplasty restores normal hemodynamics and reduces the need for reoperation when compared with the classic one-patch technique. Our current preference for SVAS repair is the Brom three-patch symmetric aortoplasty.

AB - Background: Surgical techniques for repair of supravalvular aortic stenosis (SVAS) include McGoon's one-patch, Doty's two-patch, and Brom's three-patch method. In this review we evaluated mid-term clinical outcomes of these techniques at our institution. Methods: Our cardiac surgery database identified patients with SVAS repair from 1990 to 2008. Follow-up records, reintervention and reoperation data, and most recent echocardiograms were obtained. Results: From 1990 to 2008, 20 patients (70% male) underwent surgery for SVAS. Mean age was 3.6 ± 5.6 years. In chronological sequence, 8 patients had single-patch aortoplasty, 4 had the Doty procedure, and 8 received Brom's symmetric three-patch aortoplasty. Of the Brom patients, 6 had Williams syndrome. Aortic cross-clamp times were 40.1 ± 13.6 minutes (one-patch), 60.3 ± 38.8 minutes (Doty), and 104 ± 20.5 minutes (Brom). Perioperative mortality was 5.0% (1 patient in one-patch group). Mean postoperative length of stay was 10 ± 10.6 days. Follow-up data were available for all survivors (mean follow-up, 6.3 ± 6.0 years; range, 6 months to 16 years). There were no late deaths. Follow-up echocardiograms revealed a peak Doppler gradient across the aortic outflow tract of 33 ± 18.0 mm Hg (one-patch), 10 ± 1 mm Hg (Doty), and 18 ± 12 mm Hg (Brom). All patients in the Doty and Brom groups had less than moderate aortic insufficiency. Reoperations were required in 5 of 8 one-patch patients (62%) for residual aortic stenosis (n = 3), aortic insufficiency (n = 1), and subvalvar stenosis (n = 1). No Doty or Brom patient has required aortic reoperations, which was nearly statistically associated with freedom from reoperation (p = 0.06). Subvalvar stenosis was the only risk factor associated with reoperation (p = 0.0028). Conclusions: Despite a longer cross-clamp time, SVAS repair by Doty or Brom aortoplasty restores normal hemodynamics and reduces the need for reoperation when compared with the classic one-patch technique. Our current preference for SVAS repair is the Brom three-patch symmetric aortoplasty.

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