Long-Term Outcomes of Congenital Subaortic Stenosis Surgery: Systematic Review and Meta-Analysis

All articles of this category (opens in new window) Background: Surgical resection is the standard treatment for discrete subaortic stenosis (DSS) in children. However, long-term outcomes are complicated by higher rates of recurrence and reoperation, which are reported with wide variability in the literature. Key risk factors, such as age at surgery, high preoperative peak LVOT gradient, and the benefit of concomitant myectomy, remain controversial. This systematic review and meta-analysis aim to determine the pooled long-term rates of recurrence, reoperation, and progression of aortic insufficiency (AI) and to identify significant predictors of adverse outcomes. Methods: A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for studies published between 2012 and 2025, in accordance with PRISMA guidelines. We included observational studies and trials reporting on pediatric patients < 18 years who underwent surgical resection for DSS with a minimum follow-up of 3 years. Pooled proportions for outcomes were calculated using a random-effects model; heterogeneity was assessed via I 2 , and meta-regression was performed to assess the influence of patient and surgical factors on recurrence and AI progression. Results: Seventeen retrospective cohort studies, encompassing 1,536 patients, were included, while 1,499 patients completed the follow-up. The pooled recurrence rate was 21% (95% CI: 0.15–0.28; I 2 = 88.2%; p < 0.0001). After a sensitivity analysis to ensure homogeneity, the pooled rate of recurrence requiring reoperation across 13 studies of 1,179 patients was 17% (95% CI: 15–20%; I 2 = 19.1%; p = 0.251). For patients with isolated DSS, the reoperation rate was 12% (95% CI: 6–23%; I 2 = 18.5%; p = 0.297). The pooled rate of progression to moderate or severe AI was 10% (95% CI: 8–13%; I 2 = 33%; p = 0.118). Meta-regression revealed that older median age at surgery was significantly associated with a lower reoperation rate (β=−0.2230, p = 0.0138). Conversely, a higher preoperative peak LVOT gradient was a significant predictor for AI progression (β=0.0220, p = 0.0072), with a 24.6% increase in odds for every 10 mmHg rise. The rate of myectomy showed a nonsignificant trend toward lower recurrence ( p = 0.1369). Conclusion: Surgical management of pediatric DSS carries a substantial long-term reoperation risk of 17%. Older age at initial surgery is protective against recurrence, while a high preoperative LVOT gradient is a strong independent predictor for the later progression of aortic insufficiency. These findings are crucial for risk stratification, surgical planning. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany