Abstract
Objective
We aimed to assess outcomes after aortic valve repair leading to bicuspid valve anatomy
in children.
Methods
This is a retrospective study of patients who underwent aortic valve repair with creation/preservation
of bicuspid aortic valve anatomy or tricuspidization of bicuspid valves between 1980
and 2016.
Results
Overall, 127 patients underwent bicuspid repair. Median age was 0.73 years (interquartile
range, 0.1-8.9), and median weight was 8.15 kg (interquartile range, 3.9-31.7). The
cohort included 22.8% neonates (n = 29), 28.3% infants (n = 36), and 48.8% children
(n = 62). Repair was performed without a patch in 54.3% (n = 69). Survival at 10 years
was 94.8% (95% confidence interval, 87.5-97.85). Freedom from aortic valve reoperation
at 5 and 10 years was 79.9% (95% confidence interval, 71.2-86.2) and 65.6% (95% confidence
interval, 53.4-75.3), respectively. Re-repair was undertaken in 53.7% (22/41). Freedom
from aortic valve replacement at 5 and 10 years was 90.3% (95% confidence interval,
83.1-94.5) and 75.8% (95% confidence interval, 63-84.7), respectively. Risk factors
for reoperation were age less than 1 year, unicuspid valve, and the presence of Shone
complex and concomitant aortic arch repair. There were 107 patients (107/127, 84.25%)
with preoperative bicuspid aortic valve morphology that was preserved. They were compared
with a separate cohort of 44 patients who underwent tricuspidization of bicuspid aortic
valve during the same period. There was no difference in survival or freedom from
aortic valve reoperation. However, freedom from aortic valve replacement was lower
after tricuspidization with 49.7% (95% confidence interval, 26.3-69.3) versus 75.8%
(95% confidence interval, 62.1-85.1) after 10 years (P = .0118).
Conclusions
Aortic valve repair leading to bicuspid valve anatomy in children has satisfactory
long-term results. Reoperation remains common, but the need for early valve replacement
can be effectively delayed.
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Graphical Abstract
Key Words
Abbreviations and Acronyms:
AoV (aortic valve), CI (confidence interval), EFE (endocardial fibroelastosis), HR (hazard ratio), IQR (interquartile range)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 25, 2022
Accepted:
January 11,
2022
Received in revised form:
November 17,
2021
Received:
July 22,
2021
Footnotes
The institutional human research ethics committee waived the need for informed written consent (HREC Reference Number 35205, 21/09/2015).
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: Can we ever “cure” aortic valve disease in children?The Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 1
- PreviewThe group from Melbourne1 presents a retrospective study spanning 36 years on primary aortic valve (AoV) repair performed in children (23% neonates, 29% infants). The primary goal was to compare results in the cohort that resulted in a bicuspid valve configuration with those that resulted in a tricuspid configuration. They conclude that repair strategies resulting in a bicuspid valve yields satisfactory outcomes. The bicuspid group had excellent long-term survival, and a freedom from AoV reoperation at 15 years of 32%.
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