Abstract
Objective
Difficult to repair aortic valve lesions, requiring the use of a valve substitute,
remain controversial in the face of the Ross procedure, despite undeniable technical
advances. This study was undertaken to compare midterm outcomes of children treated
using the Ross procedure or aortic valvuloplasty for complex aortic valve lesions.
Methods
Between January 2006 and December 2017, 126 patients aged younger than 18 years were
treated for complex aortic stenosis and/or aortic insufficiency and were included
in this retrospective study. Only aortic valve lesions requiring repair with an autologous
or heterologous pericardial patch were considered complex lesions. Propensity score
framework analyses were used to compare outcomes of the Ross and aortic valvuloplasty
groups while controlling for confounders.
Results
Among the 126 patients with complex aortic valve lesions, propensity score matching
selected 34 unique pairs of patients with similar characteristics. Survival (aortic
valvuloplasty, 94.1%; Ross, 91%; P = .89), freedom from overall reintervention (aortic valvuloplasty, 50.1%; Ross, 69%;
P = .32), and freedom from infective endocarditis at 8 years (aortic valvuloplasty,
100%; Ross, 85.9%; P = .21) were similar. However, freedom from reintervention in the left ventricular
outflow tract at 8 years was lower after aortic valvuloplasty than after the Ross
procedure (50.1% vs 100%, respectively; P = .001).
Conclusions
Aortic valvuloplasty and the Ross procedure yielded similar 8-year outcomes regarding
death, reoperation, and infective endocarditis although aortic valvuloplasty tended
to be associated with fewer cases of infective endocarditis. Aortic valvuloplasty
using a pericardial patch can be chosen as a first-line strategy for treating complex
aortic valve lesions and might offer the possibility of a later Ross procedure.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
AI (aortic insufficiency), AS (aortic stenosis), AVR (aortic valve replacement), CI (confidence interval), IE (infective endocarditis), IQR (interquartile range), LVOT (left ventricular outflow tract), OR (odds ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 09, 2021
Accepted:
February 26,
2021
Received in revised form:
February 23,
2021
Received:
September 6,
2020
Identification
Copyright
© 2021 by The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: Aortic valve surgery in children: Repair now, Ross procedure laterThe Journal of Thoracic and Cardiovascular SurgeryVol. 163Issue 3
- PreviewAortic valve surgery in children presents many challenges owing to the need to accommodate ongoing somatic growth.1 The 2 widely used surgical techniques, aortic valve repair and the Ross procedure, each carries its own drawbacks. Aortic valve repair has a very low risk of mortality, yet the rate of reoperation is relatively high.2 The Ross procedure has excellent freedom from reoperation but an increased risk of mortality in neonates and infants, the need for conduit replacement, and the risk of autograft dilatation and failure, especially in young children in whom the autograft cannot be effectively stabilized.
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- Commentary: Aortic valve intervention in children: The jury is still outThe Journal of Thoracic and Cardiovascular SurgeryVol. 163Issue 3
- PreviewManagement of significant aortic valve disease in children remains a significant challenge, largely due to a number of factors, including concomitant presence of associated lesions requiring intervention, lack of an appropriate-size prosthesis, lack of growth potential, and the desire to avoid anticoagulation. In this scenario, the use of a pulmonary autograft in the aortic position (Ross procedure) has become a common and effective option to relieve significant stenosis and/or regurgitation, particularly in the smallest patients, albeit at the price of reconstruction of the pathway between the right ventricle and the pulmonary artery and the associated need for recurrent reinterventions.
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