Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1997 May;225(5):503–511. doi: 10.1097/00000658-199705000-00007

Congenital aortic valve disease. Improved survival and quality of life.

R C Elkins 1, C J Knott-Craig 1, C McCue 1, M M Lane 1
PMCID: PMC1190785  PMID: 9193178

Abstract

OBJECTIVE: The purpose of the study was to assess the effect of recent trends in surgical management, including use of the Ross Operation, on improved survival and quality of life in patients treated surgically for aortic valve (AV) disease at Oklahoma Children's Hospital. BACKGROUND: Surgical treatment of congenital AV disease has proved to be palliative, but newer procedures may be improving outcomes. METHODS: A retrospective review of 301 patients, age 1 day to 26 years (median, 5 years), having a surgical AV procedure or aortic balloon valvuloplasty at Children's Hospital of Oklahoma between 1960 and February 1996, was conducted. Information was collected on all prior and subsequent operations, and follow-up within 1 year was 96% complete. RESULTS: Survival for all patients was 90% +/- 2% at age 10 years and 73% +/- 8% at age 25. By age 5, 52% +/- 4% had required an AV procedure, 89% +/- 3% by age 15. Patient survival was affected adversely by the diagnosis of valvar aortic stenosis, 79% +/- 6% at age 25 compared to 95% +/- 4% for subvalvar aortic stenosis or aortic insufficiency (p = 0.01). The AV morphology did not affect survival, but patients with a bicuspid or unicuspid valve required operative intervention at an earlier age. Survival after autograft replacement of the AV (Ross Operation) was significantly better than for other types of valve replacement (p = 0.0043). Quality of life as assessed by need for reoperation favors the use of the Ross Operation, with freedom from reoperation at 9 years of 87% +/- 7% compared to 55% +/- 5% in all patients after first AV surgery (p = 0.003). CONCLUSIONS: The Ross Operation appears to have a significant advantage in survival and quality of life in children requiring a valve replacement as a first operation or after a prior AV procedure.

Full text

PDF
503

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baudet E. M., Puel V., McBride J. T., Grimaud J. P., Roques F., Clerc F., Roques X., Laborde N. Long-term results of valve replacement with the St. Jude Medical prosthesis. J Thorac Cardiovasc Surg. 1995 May;109(5):858–870. doi: 10.1016/S0022-5223(95)70309-8. [DOI] [PubMed] [Google Scholar]
  2. Elkins R. C., Knott-Craig C. J., Ward K. E., McCue C., Lane M. M. Pulmonary autograft in children: realized growth potential. Ann Thorac Surg. 1994 Jun;57(6):1387–1394. doi: 10.1016/0003-4975(94)90089-2. [DOI] [PubMed] [Google Scholar]
  3. Elkins R. C., Lane M. M., McCue C. Pulmonary autograft reoperation: incidence and management. Ann Thorac Surg. 1996 Aug;62(2):450–455. [PubMed] [Google Scholar]
  4. Fernandez J., Laub G. W., Adkins M. S., Anderson W. A., Chen C., Bailey B. M., Nealon L. M., McGrath L. B. Early and late-phase events after valve replacement with the St. Jude Medical prosthesis in 1200 patients. J Thorac Cardiovasc Surg. 1994 Feb;107(2):394–407. [PubMed] [Google Scholar]
  5. Jones M., Barnhart G. R., Morrow A. G. Late results after operations for left ventricular outflow tract obstruction. Am J Cardiol. 1982 Sep;50(3):569–579. doi: 10.1016/0002-9149(82)90326-5. [DOI] [PubMed] [Google Scholar]
  6. KORTZ A. B., SWAN H. Direct vision trans-aortic approach to the aortic valve during hypothermia; experimental observations and report of successful clinical case. Ann Surg. 1956 Aug;144(2):205–214. doi: 10.1097/00000658-195608000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. LILLEHEI C. W., DEWALL R. A., GOTT V. L., VARCO R. L. The direct vision correction of calcific aortic stenosis by means of a pump-oxygenator and retrograde coronary sinus perfusion. Dis Chest. 1956 Aug;30(2):123–132. doi: 10.1378/chest.30.2.123. [DOI] [PubMed] [Google Scholar]
  8. Lupinetti F. M., Pridjian A. K., Callow L. B., Crowley D. C., Beekman R. H., Bove E. L. Optimum treatment of discrete subaortic stenosis. Ann Thorac Surg. 1992 Sep;54(3):467–471. doi: 10.1016/0003-4975(92)90436-8. [DOI] [PubMed] [Google Scholar]
  9. Morris C. D., Menashe V. D. 25-year mortality after surgical repair of congenital heart defect in childhood. A population-based cohort study. JAMA. 1991 Dec 25;266(24):3447–3452. [PubMed] [Google Scholar]
  10. O'Brien M. F., Stafford E. G., Gardner M. A., Pohlner P. G., Tesar P. J., Cochrane A. D., Mau T. K., Gall K. L., Smith S. E. Allograft aortic valve replacement: long-term follow-up. Ann Thorac Surg. 1995 Aug;60(2 Suppl):S65–S70. doi: 10.1016/0003-4975(95)00223-8. [DOI] [PubMed] [Google Scholar]
  11. Ross D. Pulmonary valve autotransplantation (the Ross operation). J Card Surg. 1988 Sep;3(3 Suppl):313–319. doi: 10.1111/jocs.1988.3.3s.313. [DOI] [PubMed] [Google Scholar]
  12. Stewart J. R., Merrill W. H., Hammon J. W., Jr, Graham T. P., Jr, Bender H. W., Jr Reappraisal of localized resection for subvalvar aortic stenosis. Ann Thorac Surg. 1990 Aug;50(2):197–203. doi: 10.1016/0003-4975(90)90733-m. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES