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Reoperation after isolated subaortic membrane resection

Published online by Cambridge University Press:  26 September 2019

Ziyad M. Binsalamah Open the ORCID record for Ziyad M. Binsalamah [Opens in a new window] ,
Zachary A. Spigel Open the ORCID record for Zachary A. Spigel [Opens in a new window] ,
Huirong Zhu ,
Mary B. Kim ,
Martin A. Chacon-Portillo ,
Iki Adachi ,
Michiaki Imamura ,
Carlos M. Mery ,
Emmett Dean Mckenzie  and
Charles D. Fraser jr
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Ziyad M. Binsalamah*
Affiliation:
Division of Congenital Heart Surgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Zachary A. Spigel
Affiliation:
Division of Congenital Heart Surgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Huirong Zhu
Affiliation:
Division of Outcomes and Impact Services, Texas Children’s Hospital, Houston, TX, USA
Mary B. Kim
Affiliation:
Division of Congenital Heart Surgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Martin A. Chacon-Portillo
Affiliation:
Division of Congenital Heart Surgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Iki Adachi
Affiliation:
Division of Congenital Heart Surgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Michiaki Imamura
Affiliation:
Division of Congenital Heart Surgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Carlos M. Mery
Affiliation:
Division of Congenital Heart Surgery, Texas Center for Pediatric and Congenital Heart Disease, University of Texas – Dell Medical School, Austin, TX, USA
Emmett Dean Mckenzie
Affiliation:
Division of Congenital Heart Surgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Charles D. Fraser jr
Affiliation:
Division of Congenital Heart Surgery, Texas Center for Pediatric and Congenital Heart Disease, University of Texas – Dell Medical School, Austin, TX, USA
Jeffrey S. Heinle
Affiliation:
Division of Congenital Heart Surgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
*
Author for correspondence: Z. M. Binsalamah, MD, MSc, FRCSC, Division of Congenital Heart Surgery, Texas Children’s Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6651 Main street, LT19345H, Houston, TX 77030, USA. Tel: (832) 826-1929; Fax: (832) 825-1905; E-mail: ziyadmss@gmail.com
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Abstract

Background:

The resection of a subaortic membrane remains far from a curative operation. We sought to examine factors associated with reoperation and the degree of aortic valve regurgitation as a potential long-term source for reoperation.

Methods:

All patients who underwent resection of an isolated subaortic membrane between 1995 and 2018 were included. Patients who underwent other procedures were excluded. Paired categorical data were compared using McNemar’s test. Univariate time-to-event analyses were performed using Kaplan–Meier methods with log-rank tests for categorical variables and univariate Cox models for continuous variables.

Results:

A total of 84 patients (median age 6.6, 31% females) underwent resection of isolated subaortic membrane. At a median follow-up of 9.3 years (interquartile range 0.6–22.5), 12 (14%) patients required one reoperation and 1 patient required two reoperations. Median time to first reoperation was 4.6 years. The degree of aortic valve regurgitation improved post-operatively from pre-operatively (p = 0.0007); however, the degree of aortic valve regurgitation worsened over the course of follow-up (p = 0.010) to equivalence with pre-operative aortic valve regurgitation (p = 0.18). Performance of a septal myectomy was associated with longer freedom from reoperation (p = 0.004).

Conclusions:

In patients with isolated subaortic membranes, performance of a septal myectomy can minimise risk for reoperation. Patients should be serially monitored for degradation of the aortic valve, even if aortic regurgitation is not present post-operatively.

Keywords

Subaortic membraneleft-ventricular outflow tractaortic valve
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 11 , November 2019 , pp. 1391 - 1396
Copyright
© Cambridge University Press 2019 

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Footnotes

Meeting Presentation (Podium): 55th Annual Meeting of the Society of Thoracic Surgeons, San Diego, CA, January 28, 2019

References

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