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
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)To read this article in full you will need to make a payment
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References
- Aortic valve surgery in congenital heart disease: a single-center experience.Artif Organs. 2010; 34: E85-E90
- The direct vision correction of calcific aortic stenosis by means of a pump-oxygenator and retrograde coronary sinus perfusion.Dis Chest. 1956; 30: 123-132
- Aortic valve surgery in children.J Thorac Cardiovasc Surg. 2020; ([In press])
- Long-term results of a strategy of aortic valve repair in the pediatric population.J Thorac Cardiovasc Surg. 2013; 145 (discussion 467-9): 461-467
- Outcomes after operations for bicuspid aortic valve disease in the pediatric population.Ann Thorac Surg. 2013; 96: 2175-2183
- Progression of aortic regurgitation after different repair techniques for congenital aortic valve stenosis.Pediatr Cardiol. 2016; 37: 84-89
- Aortic valve repair for insufficiency in older children offers unpredictable durability that may not be advantageous over a primary Ross operation.Eur J Cardiothorac Surg. 2016; 49: 883-892
- Aortic stenosis of the neonate: a single-center experience.J Thorac Cardiovasc Surg. 2019; 157: 318-326.e1
- Surgical valvotomy and repair for neonatal and infant congenital aortic stenosis achieves better results than interventional catheterization.J Am Coll Cardiol. 2013; 62: 2134-2140
- Valve repair in congenital aortic valve abnormalities.Interact Cardiovasc Thorac Surg. 2010; 10: 587-591
- Neonatal surgical aortic commissurotomy: predictors of outcome and long-term results.Ann Thorac Surg. 2006; 82: 1585-1592
- Twenty years experience of surgical aortic valvotomy for critical aortic stenosis in early infancy.Eur J Cardiothorac Surg. 2006; 30: 35-40
- Surgical aortic valvuloplasty in children and adolescents with aortic regurgitation: acute and intermediate effects on aortic valve function and left ventricular dimensions.J Thorac Cardiovasc Surg. 2008; 135 (559.e1-3): 552-559
- Surgical valvuloplasty versus balloon aortic dilation for congenital aortic stenosis: are evidence-based outcomes relevant?.Ann Thorac Surg. 2012; 94 (discussion 153-5): 146-153
- The long-term outcome of open valvotomy for critical aortic stenosis in neonates.Ann Thorac Surg. 2012; 94: 1519-1526
- Contemporary experience with surgical treatment of aortic valve disease in children.J Thorac Cardiovasc Surg. 2013; 146 (discussion 520-1): 512-520
- Outcome of a repair-oriented strategy for the aortic valve in children.World J Pediatr Congenit Heart Surg. 2014; 5: 191-199
- Balloon dilation and surgical valvotomy comparison in non-critical congenital aortic valve stenosis.Pediatr Cardiol. 2015; 36: 616-624
- The mid-term outcome of primary open valvotomy for critical aortic stenosis in early infancy – a retrospective single center study over 18 years.J Cardiothorac Surg. 2016; 11: 116
- Comparison of balloon dilatation and surgical valvuloplasty in non-critical congenital aortic valvular stenosis at long-term follow-up.Pediatr Cardiol. 2018; 39: 1554-1560
- Aortic valve interventions in pediatric patients.Semin Thorac Cardiovasc Surg. 2019; 31: 277-287
- Ross procedures in children with previous aortic valve surgery.J Am Coll Cardiol. 2020; 76: 1564-1573
- Ross operation in children: 23-year experience from a single institution.Ann Thorac Surg. 2020; 109: 1251-1259
- The Ross procedure using autologous support of the pulmonary autograft: techniques and late results.J Thorac Cardiovasc Surg. 2015; 149: S46-S52
- Improved survival after the Ross procedure compared with mechanical aortic valve replacement.J Am Coll Cardiol. 2018; 71: 1337-1344
Article info
Publication history
Published online: December 12, 2020
Accepted:
November 22,
2020
Received in revised form:
October 23,
2020
Received:
April 24,
2020
Footnotes
Dr Naimo is supported by a National Health and Medical Research Council Medical Research Postgraduate Scholarship (1150242). Dr d'Udekem is a Practitioner Fellow of the National Health and Medical Research Council of Australia (1082186).
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: Aortic valvuloplasty au naturel, where longevity is not just skin deepThe Journal of Thoracic and Cardiovascular SurgeryVol. 162Issue 4
- PreviewIn 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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