Faculty Collaboration Database

Complex aortic valve repair as a durable and effective alternative to valve replacement in children with aortic valve disease. J Thorac Cardiovasc Surg 2005 Mar;129(3):551-8

Date

03/05/2005

Pubmed ID

15746738

DOI

10.1016/j.jtcvs.2004.09.033

Scopus ID

2-s2.0-14644444528 (requires institutional sign-in at Scopus site)   53 Citations

Abstract

OBJECTIVE: This study was undertaken to determine the utility of aortic valve repair in children.

METHODS: A retrospective analysis was conducted on aortic valve surgery from 1973 to 2004 at Children's Hospital of Wisconsin.

RESULTS: Procedures were classified as simple repairs (blunt valvotomy, commissurotomy with or without thinning, n = 147), repair of aortic insufficiency with ventricular septal defect (n = 22), complex repairs (any combination of additional procedures including suspension of prolapsed leaflets, leaflet extensions, repair of torn or perforated leaflets, annuloplasty, reduction of sinus of Valsalva plasty, and concomitant repair of supravalvular or subvalvular stenosis, n = 57), and replacements (n = 57, 20 mechanical, 2 porcine, and 35 human valves). Freedoms from reintervention for simple repairs and repair of aortic insufficiency with ventricular septal defect at 10 years were 86% +/- 5% and 93.3% +/- 6%, respectively. For complex valve repair, freedoms from reintervention at 1, 5, and 10 years were 94% +/- 3%, 85% +/- 6%, and 44% +/- 15%, versus 96% +/- 3%, 77% +/- 9%, and 77% +/- 9% for valve replacement ( P = .3). At intermediate follow-up, patients with complex valve repair had a residual gradient of 20 +/- 21 mm Hg, and 94% were free of severe aortic insufficiency. Residual aortic stenosis ( P < .05) but not the preoperative diagnosis of combined aortic stenosis and insufficiency predicted the need for reintervention.

CONCLUSION: Freedom from reintervention after complex valve repairs was not different from that after valve replacement, with acceptable residual aortic stenosis and insufficiency. Simple repairs and repair of aortic insufficiency with ventricular septal defect yielded excellent long-term freedom from reintervention.

Author List

Tweddell JS, Pelech AN, Frommelt PC, Jaquiss RD, Hoffman GM, Mussatto KA, Litwin SB

Authors

Peter C. Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Kathleen Mussatto Ph.D. Associate Professor in the School of Nursing department at Milwaukee School of Engineering

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aortic Valve
Aortic Valve Insufficiency
Aortic Valve Stenosis
Cardiac Surgical Procedures
Child
Child, Preschool
Heart Septal Defects, Ventricular
Humans
Infant
Infant, Newborn
Reoperation
Retrospective Studies