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Resection of subaortic membrane for discrete subaortic stenosis
Author(s) -
Talwar Sachin,
Anand Abhishek,
Gupta Saurabh Kumar,
Ramakrishnan Sivasubramanian,
Kothari Shyam Sunder,
Saxena Anita,
Juneja Rajnish,
Choudhary Shiv Kumar,
Airan Balram
Publication year - 2017
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.13160
Subject(s) - medicine , ventricular outflow tract , septal myectomy , regurgitation (circulation) , stenosis , cardiology , resection , surgery , retrospective cohort study , confidence interval , doppler echocardiography , hypertrophic cardiomyopathy , blood pressure , obstructive cardiomyopathy , diastole
Background We reviewed the long‐term results of surgery for discrete subaortic membrane (SubAM) from a single institute. Methods A retrospective review of medical records of all patients (n = 146) who underwent resection of a SubAM for discrete subaortic stenosis between 1990 and 2015 at the All India Institute of Medical Sciences, New Delhi, India was undertaken. Results Median age at surgery was 9.0 years (9 months‐47 years). There was one early death. Preoperative peak left ventricular outflow tract (LVOT) Doppler gradient was 83.4 ± 26.2 mmHg (range: 34‐169 mmHg). On preoperative echocardiography, aortic regurgitation (AR) was absent in 69 (47.3%), mild in 35 (24%), moderate in 30 (20.5%), and severe in 12 (8.2%). After surgery, the LVOT gradient was reduced to 15.1 ± 6.2 mmHg ( P < 0.001). Fourteen patients (9.6%) who had residual/recurrent significant gradients are currently being followed‐up or awaiting surgery. There was improvement in AR for operated patients with freedom from AR of 92.6 ± 0.03% at 15 years. Kaplan‐Meier survival at 25 years was 93.0 ± 3.9% (95% confidence interval: 79.6, 97.7). Freedom from re‐operation at 25 years was 96.9 ± 1.8%. Conclusions Long‐term results of surgery for discrete SubAM are good. Resection of the membrane along with septal myectomy decreases the risk of recurrence.