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Aortic valve repair in children without use of a patch

  • Fraser R.O. Wallace
    Affiliations
    Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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  • Edward Buratto
    Affiliations
    Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, The University of Melbourne, Melbourne, Australia

    Murdoch Children's Research Institute, Melbourne, Australia
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  • Phillip S. Naimo
    Affiliations
    Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, The University of Melbourne, Melbourne, Australia

    Murdoch Children's Research Institute, Melbourne, Australia
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  • Johann Brink
    Affiliations
    Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, The University of Melbourne, Melbourne, Australia

    Murdoch Children's Research Institute, Melbourne, Australia
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  • Yves d'Udekem
    Affiliations
    Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, The University of Melbourne, Melbourne, Australia

    Murdoch Children's Research Institute, Melbourne, Australia

    Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
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  • Christian P. Brizard
    Affiliations
    Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, The University of Melbourne, Melbourne, Australia

    Murdoch Children's Research Institute, Melbourne, Australia
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  • Igor E. Konstantinov
    Correspondence
    Address for reprints: Igor E. Konstantinov, MD, PhD, Cardiac Surgery Unit, The Royal Children's Hospital, Flemington Rd, Parkville 3052, Australia.
    Affiliations
    Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia

    Department of Paediatrics, The University of Melbourne, Melbourne, Australia

    Murdoch Children's Research Institute, Melbourne, Australia

    Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
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Published:December 12, 2020DOI:https://doi.org/10.1016/j.jtcvs.2020.11.159

      Abstract

      Background

      We aimed to assess the long-term outcomes of children in whom the aortic valve could be repaired without the use of patch material. We hypothesized that if the aortic valve is of sufficiently good quality to perform repair without patches, a durable repair could be achieved.

      Methods

      All children (n = 102) who underwent aortic valve repair without the use of a patch between 1980 and 2016 were reviewed.

      Results

      The median patient age at operation was 2 years (interquartile range, 1 month to 9.6 years). There were 25 neonates and 17 infants. There was no operative mortality. Mean overall survival at 10 years was 97.7% ± 0.01% (95% confidence interval, [CI] 91.0%-99.4%). Forty-three patients (42.2%) required 56 aortic valve reoperations, including 24 redo aortic valve repairs, 22 Ross procedures, 8 mechanical aortic valve replacements, and 2 homograft aortic valve replacements. Mean freedom from aortic valve reoperation at 10 years was 57.4% ± 0.06% (95% CI, 44.9%-68.1%), and freedom from aortic valve replacement at 10 years was 74.5% ± 0.05% (95% CI, 63.0%-82.9%) at 10 years. Freedom from aortic valve reoperation at 10 years was 33.1% ± 0.1% (95% CI, 14.5%-53.2%) in neonates and 68.9% ± 0.06% (95% CI, 54.5%-79.6%) in older children (P < .01).

      Conclusions

      In approximately one-third of children undergoing aortic valve repair, the repair could be achieved without patches. In these children, aortic valve repair was achieved without operative mortality. Infants and older children have low reoperation rates, whereas reoperation rates in neonates are higher. Initial repair allows valve replacement to be delayed to later in childhood, when a more durable result may be achieved.

      Graphical abstract

      Key Words

      Abbreviations and Acronyms:

      AI (aortic insufficiency), AoV (aortic valve), AS (aortic stenosis), CI (confidence interval), HR (hazard ratio), IQR (interquartile range), LVOT (left ventricular outflow tract), SAS (subaortic stenosis), VSD (ventricular septal defect)
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      Linked Article

      • Commentary: Aortic valvuloplasty au naturel, where longevity is not just skin deep
        The Journal of Thoracic and Cardiovascular SurgeryVol. 162Issue 4
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          In this month's edition of the Journal, Wallace and colleagues1 explore the benefits of performing an aortic valvuloplasty in children without needing to use a patch. Spanning 36 years, this institution, which predominantly pursues surgical versus catheter-based intervention for aortic valve disease, performed aortic valvuloplasty on 102 children without the use of patch augmentation (102 of a total of 352 undergoing valvuloplasty). In this cohort, there were no early mortalities and the freedom from valve reintervention was 84%, 57%, and 35% at 5, 10, and 15 years.
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