Clinical profile of patients operated on for sub-aortic stenosis and factors associated with postoperative recurrence

Subaortic stenosis remains difficult to manage due to the unpredictable progression of the stenosis and the high rate of recurrence after surgical treatment. The aims of our study were to describe the clinical and paraclinical profile of patients operated on for subaortic stenosis and to analyze the factors associated with postoperative recurrence of the subaortic obstacle. This study was based on a retrospective observational study on all cases of subaortic stenosis operated on and collected in the cardiology department of the University Hospital of Sfax between January 1, 2010 and December 31, 2020. We studied the relationships between demographic, clinical, paraclinical variables and the recurrence of the subaortic obstruction in operated patients. We included 28 patients (18 men/10 women). At the time of diagnosis, symptoms were present in 67.85% of patients and a peak subaortic gradient ≥ 50 mmHg on echocardiography was present in 82.14% of patients. The mean age at the time of surgery was 10.43 years. Resection of the subaortic membrane was the most frequently used technique (46.4%). Operative mortality was zero. Recurrence, defined by the persistence of a peak subaortic gradient ≥ 50 mmHg in the medium and long term, was observed in 7 patients (25%), 6 of whom underwent reoperation. Recurrence was more frequent in patients with a preoperative peak subaortic gradient ≥ 70 mmHg compared to those with a peak gradient < 70 mmHg (60% versus 5.6%, P = 0.001) and in patients with a post-operative residual gradient ≥ 30 mmHg compared to those with a residual gradient < 30 mmHg (75% versus 5%, P < 0.001). Subaortic stenosis is a very polymorphic and progressive heart disease. The surgery provides good functional and hemodynamic results. Despite the late age of patients at diagnosis and surgery, our results were favorable in the short term, but recurrence was frequent in the medium and long term.