• Michael O Murphy, Jared P Beller, Jordan P Bloom, Claudia Montanaro, Andreas Hoschtitzky, Darryl Shore, Carles Bautista, and Alain Fraisse.
• Department of Paediatric Cardiac Surgery, Royal Brompton Hospital & National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Adult Congenital Heart Disease, Royal Brompton Hospital & National Heart and Lung Institute, Imperial College London, London, United Kingdom. Electronic address: moamurphy@mac.com.
• J. Thorac. Cardiovasc. Surg. 2024 Oct 2.

ObjectiveTo evaluate the influence of initial intervention on the long-term outcomes in congenital aortic stenosis.MethodsTwo hundred forty-three children underwent initial intervention between 1997 and 2022, by surgical valvuloplasty in 92 (32% neonates, 36% infants) and balloon valvuloplasty in 151 (27% neonates, 30% infants). Twenty-eight patients (11.5%) had associated mitral valve stenosis. Competing risk analysis for death, alive after initial intervention, or alive after aortic valve replacement (AVR) was performed and factors influencing survival or AVR examined.ResultsThere were 9 early deaths (3.7%). During a median follow-up of 13.5 years (range, 1.5-26.7), 98 patients had reintervention on the aortic valve (40.3%), whereas 145 had AVR (59.6%) at a median age of 14.0 years (interquartile range, 9.0-17.0), which was by Ross procedure in 130 (89.6%). Of the 12 late deaths, 3 were perioperative and 9 occurred as outpatients. There were no perioperative or late deaths after AVR. AVR occurred earlier in patients who had initial balloon (12.0 years [interquartile range, 5.0-14.5]) rather than surgical (18.5 years [interquartile range, 15.5-21.5]) valvuloplasty (P < .05). Actuarial survival in the cohort was 91.3% at 25 years, with no difference between the 2 initial interventions. Critical aortic stenosis, mitral stenosis, and initial intervention as a neonate were independent risk factors for worse survival.ConclusionsWe demonstrate excellent early and late survival in patients with congenital aortic stenosis after initial balloon or surgical valvuloplasty. Whilst children who had balloon valvuloplasty had AVR earlier than those who had initial surgical valvuloplasty, patient factors had a greater influence on survival than choice of initial intervention.Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.

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