Modified simple sliding aortoplasty for preserving the sinotubular junction without using foreign material for congenital supravalvar aortic stenosis

Abstract

Objective: The surgical approach for treating supravalvar aortic stenosis (SVAS) has evolved from a plain patch technique to a three-dimensional patch repair, which has some drawbacks. Here, we report on the midterm outcomes after using our modified simple sliding aortoplasty preserving sinotubular junction without foreign material for surgical correction of SVAS. Methods: Between June 2001 and February 2010, 18 children (median age, 6.2 years; range 0.5-2.2 years) with discrete SVAS underwent surgical repair. After a standard median sternotomy, cardiopulmonary bypass and cardioplegic arrest, the aorta was transected obliquely just distal to the point of stenosis. An incision was then made into the non-coronary sinus of the proximal aorta, and a counterincision was made into the lesser curvature of the ascending aorta, after which, the proximal and distal aorta were anastomosed directly with a running suture. Peak pressure gradients were estimated using echocardiography and the data were reviewed retrospectively. Results: The median follow-up period was 39.6 months (range, 1-104.5 months). There was no early or late death. No patients required re-operation. Ten patients had Williams-Beuren syndrome. There were eight cases of concomitant pulmonary artery angioplasty. The mean pressure gradient decreased from 65.9 ± 18.4. mmHg preoperatively to 15.2 ± 8.9. mmHg at the final follow-up (P = 0.01). There was no significant, more than mild aortic regurgitation. Conclusions: Our modified simple sliding aortoplasty showed excellent surgical results, and may be a good option for discrete SVAS. © 2011 European Association for Cardio-Thoracic Surgery.