Incidence of Reoperation After Surgical Procedure for Left Ventricular Outflow Tract Obstruction in Children and Young Adults |
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| Institution: | 1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota;2. Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota;3. Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota;1. Heart Center, Intermountain Primary Children’s Hospital, Salt Lake City, Utah;2. Division of Pediatric Infectious Disease, University of Utah, Salt Lake City, Utah;3. Division of Pediatric Critical Care, University of Utah, Salt Lake City, Utah;4. Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah;5. Division of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah;6. Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah;1. Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts;2. Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts;3. Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts;4. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;5. Department of Surgery, Harvard Medical School, Boston, Massachusetts |
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| Abstract: | BackgroundThe common causes of subaortic left ventricular outflow tract obstruction (LVOTO) are hypertrophic cardiomyopathy (HCM) and membranous/tunnel subaortic stenosis (SAS). Reoperation after corrective surgery may be due to recurrent disease, associated congenital defects, or complications of the initial procedure. This study compares the late outcomes of young patients with HCM and SAS.MethodsWe studied clinical, echocardiographic, and operative data of patients ≤21 years of age at the time of surgery for LVOTO between August 1963 and August 2018. We stratified patients into HCM (n = 152) and congenital SAS (n = 63) groups and compared survival and cumulative incidence of reoperation.ResultsAt initial repair, patients with HCM were older than patients with SAS (median interquartile range] age, 15 10-19] years vs 8 5-13] years; P < .001), and patients with HCM were more symptomatic with dyspnea (P < .001), chest pain (P = .002), and presyncope/syncope (P = .005). Thirty-day mortality was 1.3% vs 0% for HCM and SAS groups. During a median follow-up of 13.1 years, survival was similar through the first 10 years; but during the second decade, patients with HCM had poorer survival (survival at 20 years, 80% vs 91% for patients with SAS; P = .007). Ten years after repair, reoperation for recurrent LVOTO was performed in 5% of patients with HCM vs 31% in those with SAS (P < .001).ConclusionsIn this surgical cohort, patients with HCM were more symptomatic preoperatively than those with SAS. Late survival of patients with SAS was superior to that of patients with HCM despite a greater need for reoperation. |
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