Contemporary results of aortic valve repair for congenital disease: lessons for management and staged strategy. Eur J Cardiothorac Surg 2017 Sep 01;52(3):581-587
Date
09/07/2017Pubmed ID
28874025DOI
10.1093/ejcts/ezx172Scopus ID
2-s2.0-85045010364 (requires institutional sign-in at Scopus site) 34 CitationsAbstract
OBJECTIVES: Any aortic valve (AoV) operation in children (repair, Ross or mechanical replacement) is a palliation and reinterventions are frequent. AoV repair is a temporary solution primarily aimed at allowing the patient to grow to an age when more definitive solutions are available. We retrospectively analysed AoV repair effectiveness across the whole age spectrum of children, excluding neonates and AoV disease secondary to congenital heart disease.
METHODS: From 2003 to 2015, 193 consecutive patients were included. The mean age was 9.2 ± 6.9 years (22% <1 year); 86 (45%) had a preceding balloon valvuloplasty. The indications for the procedure were stenotic (n = 123; 64%), regurgitant (n = 63; 33%) or combined (n = 7; 4%) disease. The procedures performed were commissurotomy shaving (n = 74; 38%), leaflet replacement (n = 78; 40%), leaflet extension (n = 21; 11%) and neocommissure creation (n = 21; 11%). Post-repair geometry was tricuspid in 137 (71%) patients.
RESULTS: The 10-year survival rate was 97.1%. Freedom from reoperation and replacement at 7 years was, respectively, 57% (95% confidence interval, 47-66) and 68% (95% confidence interval, 59-76). In multivariate analysis, balloon dilatation before 6 months, the absence of a developed commissure, a non-tricuspid post-repair geometry and cross-clamp duration were predictors for reoperation and replacement. After a mean follow-up period of 5.1 ± 3.0 years, 145 (75%) patients had a preserved native valve, with undisturbed valve function (peak gradient <40 mmHg, regurgitation ≤mild) in 113 (58%).
CONCLUSIONS: Aortic valve repair in children is safe and effective in delaying the timing for more definitive solution. Surgical strategy should be individualized according to the age of the patient. Avoidance of early balloon dilatation and aiming for a tricuspid post-repair arrangement may improve outcomes.
Author List
Vergnat M, Asfour B, Arenz C, Suchowerskyj P, Bierbach B, Schindler E, Schneider M, Hraska VAuthor
Viktor Hraska MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aortic Valve
Child
Child, Preschool
Disease Management
Disease-Free Survival
Echocardiography, Transesophageal
Female
Follow-Up Studies
Forecasting
Germany
Heart Defects, Congenital
Heart Valve Diseases
Heart Valve Prosthesis Implantation
Humans
Infant
Infant, Newborn
Male
Practice Guidelines as Topic
Reoperation
Retrospective Studies
Survival Rate
Young Adult
