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Notenboom ML, Rhellab R, Etnel JRG, van den Bogerd N, Veen KM, Taverne YJHJ, Helbing WA, van de Woestijne PC, Bogers AJJC, Takkenberg JJM. Aortic valve repair in neonates, infants and children: a systematic review, meta-analysis and microsimulation study. Eur J Cardiothorac Surg 2023; 64:ezad284. [PMID: 37584683 PMCID: PMC10502195 DOI: 10.1093/ejcts/ezad284] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/24/2023] [Accepted: 08/14/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVES To support clinical decision-making in children with aortic valve disease, by compiling the available evidence on outcome after paediatric aortic valve repair (AVr). METHODS A systematic review of literature reporting clinical outcome after paediatric AVr (mean age at surgery <18 years) published between 1 January 1990 and 23 December 2021 was conducted. Early event risks, late event rates and time-to-event data were pooled. A microsimulation model was employed to simulate the lives of individual children, infants and neonates following AVr. RESULTS Forty-one publications were included, encompassing 2 623 patients with 17 217 patient-years of follow-up (median follow-up: 7.3 years; range: 1.0-14.4 years). Pooled mean age during repair for aortic stenosis in children (<18 years), infants (<1 year) or neonates (<30 days) was 5.2 ± 3.9 years, 35 ± 137 days and 11 ± 6 days, respectively. Pooled early mortality after stenosis repair in children, infants and neonates, respectively, was 3.5% (95% confidence interval: 1.9-6.5%), 7.4% (4.2-13.0%) and 10.7% (6.8-16.9%). Pooled late reintervention rate after stenosis repair in children, infants and neonates, respectively, was 3.31%/year (1.66-6.63%/year), 6.84%/year (3.95-11.83%/year) and 6.32%/year (3.04-13.15%/year); endocarditis 0.07%/year (0.03-0.21%/year), 0.23%/year (0.07-0.71%/year) and 0.49%/year (0.18-1.29%/year); and valve thrombosis 0.05%/year (0.01-0.26%/year), 0.15%/year (0.04-0.53%/year) and 0.19%/year (0.05-0.77%/year). Microsimulation-based mean life expectancy in the first 20 years for children, infants and neonates with aortic stenosis, respectively, was 18.4 years (95% credible interval: 18.1-18.7 years; relative survival compared to the matched general population: 92.2%), 16.8 years (16.5-17.0 years; relative survival: 84.2%) and 15.9 years (14.8-17.0 years; relative survival: 80.1%). Microsimulation-based 20-year risk of reintervention in children, infants and neonates, respectively, was 75.2% (72.9-77.2%), 53.8% (51.9-55.7%) and 50.8% (47.0-57.6%). CONCLUSIONS Long-term outcomes after paediatric AVr for stenosis are satisfactory and dependent on age at surgery. Despite a high hazard of reintervention for valve dysfunction and slightly impaired survival relative to the general population, AVr is associated with low valve-related event occurrences and should be considered in children with aortic valve disease.
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Affiliation(s)
- Maximiliaan L Notenboom
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Reda Rhellab
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Nova van den Bogerd
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Willem A Helbing
- Department of Paediatrics, Div. of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
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Sassis L, Kefala-Karli P, Cucchi I, Kouremenos I, Demosthenous M, Diplaris K. Valve Repair in Aortic Insufficiency: A State-of-the-art Review. Curr Cardiol Rev 2023; 19:e270422204131. [PMID: 35490315 PMCID: PMC10201877 DOI: 10.2174/1573403x18666220427120235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 02/08/2023] Open
Abstract
Aortic valve insufficiency (AI) describes the pathology of blood leaking through the aortic valve to the left ventricle during diastole and is classified as mild, moderate or severe according to the volume of regurgitating blood. Intervention is required in severe AI when the patient is symptomatic or when the left ventricular function is impaired. Aortic valve replacement has been considered the gold standard for decades for these patients, but several repair techniques have recently emerged that offer exceptional stability and long-term outcomes. The appropriate method of repair is selected based on the mechanism of AI and each patient's anatomic variations. This review aims to describe different pathologies of AI based on its anatomy, along with the different surgical techniques of aortic repair and their reported results.
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Affiliation(s)
| | | | - Irene Cucchi
- University of Nicosia, School of Medicine, Nicosia, Cyprus
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Huang F, Li L, Qin W, Su C, Wang L, Xiao L, Chen X. Partial aortic root remodeling for root reconstruction in patients with acute type A dissection. J Biomed Res 2016; 30:411-418. [PMID: 27845304 PMCID: PMC5044713 DOI: 10.7555/jbr.30.20150097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/05/2015] [Accepted: 12/25/2015] [Indexed: 11/07/2022] Open
Abstract
In the present study, we reported our experience with partial aortic root remodeling for root reconstruction in patients with acute type A dissection, which involves in non-coronary sinus and/or the right coronary sinus with just one trimmed Dacron graft. Between February 2001 and May 2010, we performed partial aortic root remodeling in 40 patients, who underwent emergency surgical intervention. The dissected sinuses were excised leaving a 3-5 mm rim of the aortic wall from the attached aortic valve cusps. A short piece (4-5 cm) of collagen coated woven polyester vascular prosthesis was trimmed with one or two “tongues” to reconstruct the non-coronary sinus and/or the right coronary sinus, but without using separated patches. Additional procedures were including hemi-arch replacement in 11 patients, and total arch replacement plus stent-elephant trunk in 20 patients. The mean follow-up time was 36.4±3.6 months. In-hospital mortality was only 5.0% (2/40); furthermore, 3 (8.6%) patients underwent re-operation of the aortic valve and 2 (5.7%) patients died during follow-up. At the end of follow-up, trivial or no aortic regurgitation was found in 33 patients, but mild aortic regurgitation was found in 2 patients. Our data suggest that the early and mid-term results of partial aortic root remodeling were favorable, and it restored valve durability and function. Thus, the use of technique for root reconstruction in patients with acute type A dissection should be vigorously encouraged.
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Affiliation(s)
- Fuhua Huang
- Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital affiliated to Nanjing Medical University, Nanjing Cardiovascular Disease Research Institute, Nanjing, Jiangsu 210006, China
| | - Liangpeng Li
- Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital affiliated to Nanjing Medical University, Nanjing Cardiovascular Disease Research Institute, Nanjing, Jiangsu 210006, China
| | - Wei Qin
- Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital affiliated to Nanjing Medical University, Nanjing Cardiovascular Disease Research Institute, Nanjing, Jiangsu 210006, China
| | - Cunhua Su
- Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital affiliated to Nanjing Medical University, Nanjing Cardiovascular Disease Research Institute, Nanjing, Jiangsu 210006, China
| | - Liming Wang
- Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital affiliated to Nanjing Medical University, Nanjing Cardiovascular Disease Research Institute, Nanjing, Jiangsu 210006, China
| | - Liqiong Xiao
- Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital affiliated to Nanjing Medical University, Nanjing Cardiovascular Disease Research Institute, Nanjing, Jiangsu 210006, China
| | - Xin Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital affiliated to Nanjing Medical University, Nanjing Cardiovascular Disease Research Institute, Nanjing, Jiangsu 210006, China;
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Garatti A, Canziani A, Menicanti L, Tripepi S, Simeoni S, Mossuto E, Santoro T, Montericcio V, Pelissero G. Aortic valve decalcification for severe aortic valve stenosis in the elderly: medium-term results. J Cardiovasc Med (Hagerstown) 2015; 17:130-6. [PMID: 26258720 DOI: 10.2459/jcm.0000000000000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To present the results of a novel technique of aortic valve decalcification (AVD) in a consecutive population of elderly patients with severe aortic valve stenosis (AVS) and small aortic annulus. METHODS Between January 2008 and December 2012, a consecutive series of 34 patients (mean age 80 ± 13 years) with severe AVS were operated on using AVD. They were compared with a matched population of 68 patients (mean age 82 ± 7 years) submitted to aortic valve replacement (AVR) with bioprosthesis. The two groups were comparable for cardiac risk factors and admission symptoms. Preoperatively, all patients presented with severe AVS, small aortic annulus (19 mm) and preserved left ventricular function. RESULTS Thirty-day mortality was 8.8 vs. 7.5% in the AVD and AVR groups, respectively (P = 0.88). Actuarial 2 and 5-year survival rates were 80 vs. 82% and 64 vs. 78% in the AVD and AVR groups, respectively (P = 0.27). Long-term valve-related events incidence was significantly higher in the AVD group (12%) compared with that in the AVR group (4%; P = 0.01). However, in the AVD group, patients with no or mild residual AR experienced 2 and 5 years of freedom from valve-related events, which is not significantly different from the patients submitted to the AVR group (P = 0.76). After AVD, a significant increase in the aortic valve area (from 0.8 to 1.9 cm) and a parallel reduction in the mean gradient (from 40 to 12 mmHg) was observed in all patients (P = 0.01). Postoperative aortic valve area (1.9 vs. 1.26 cm), as well as mean gradient (12 vs. 21 mmHg), were significantly better in the AVD group compared with that in the AVR group (P = 0.01). CONCLUSION In this preliminary experience, AVD seems a good therapeutic option for elderly patients with severe AVS. Further studies with longer follow-up are needed in order to confirm these preliminary results and to ascertain the valve durability over time.
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Affiliation(s)
- Andrea Garatti
- aCardiac Surgery II Unit bEchocardiography Laboratory cScientific Directorate, IRCCS Policlinico San Donato, Milan dDivision of Cardiology, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
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Ekhomu O, Naheed ZJ. Aortic Involvement in Pediatric Marfan syndrome: A Review. Pediatr Cardiol 2015; 36:887-95. [PMID: 25669767 DOI: 10.1007/s00246-015-1101-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/07/2015] [Indexed: 01/07/2023]
Abstract
Outlining specific protocols for the management of pediatric patients with Marfan syndrome has been challenging. This is mostly due to a dearth of clinical studies performed in pediatric patients. In Marfan syndrome, the major sources of morbidity and mortality relate to the cardiovascular system. In this review, we focus on aortic involvement seen in pediatric patients with Marfan syndrome, ranging from aortic dilatation to aortic rupture and heart failure. We discuss the histological, morphological, and pathogenetic basis of the cardiac manifestations seen in pediatric Marfan syndrome and use a specific case to depict our experienced range of cardiovascular manifestations. The survival for patients with Marfan syndrome may approach the expected survival for non-affected patients, with optimal management. With this potentiality in mind, we explore possible and actual management considerations for pediatric Marfan syndrome, examining both medical and surgical therapy modalities that can make the possibility of improved survival a reality.
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Affiliation(s)
- Omonigho Ekhomu
- Department of Pediatrics, John H. Stroger Hospital, 1901 W. Harrison Street, Chicago, IL, USA,
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Kent WDT, Toeg HD, Appoo JJ. Repair of bicuspid aortic valve in the presence of endocarditis and leaflet perforation. Tex Heart Inst J 2014; 41:67-9. [PMID: 24512405 DOI: 10.14503/thij-12-3049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aortic valve repair can be a good option in younger patients who have severe aortic regurgitation. A systematic, disease-directed approach can simplify repair. This case report describes how a simplified approach can be successfully applied to complex pathologic conditions of the aortic valve. A 49-year-old man with a bicuspid aortic valve and a history of endocarditis presented with severe aortic regurgitation and evidence of recurrent infection. Intraoperatively, we found congenital and degenerative aortic anatomy with endocarditis and perforation. We performed aortic valve repair to enable leaflet coaptation and to adjust the coaptation height. After 24 months, the patient remained well, with an intact repair and trivial aortic regurgitation. We describe our systematic repair approach and rationales for targeting repairs to identified lesions. To our knowledge, this is the first description of complex aortic valve repairs in a patient who had simultaneous congenital, degenerative, and infectious conditions.
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Affiliation(s)
- William D T Kent
- Division of Cardiac Surgery, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta T2N 2T9, Canada
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Kim H, Bergman R, Matyal R, Khabbaz KR, Mahmood F. Three-dimensional echocardiography and en face views of the aortic valve: technical communication. J Cardiothorac Vasc Anesth 2013; 27:376-80. [PMID: 23507016 DOI: 10.1053/j.jvca.2012.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Indexed: 01/30/2023]
Abstract
With the resurgence in popularity of aortic valve (AV) repair, detailed anatomical information of the AV has become invaluable for surgical decision making as well as for evaluation of success postrepair. Perioperative 3-dimensional echocardiography is optimally suited to assist in repair planning. The volumetric nature of the 3-dimensional data allows accurate derivation of qualitative and quantitative measurements. A uniform approach to imaging and description of echocardiographic AV anatomy is essential to facilitate communication across specialties.
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Affiliation(s)
- Han Kim
- Department of Anesthesia & Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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von Knobelsdorff-Brenkenhoff F, Trauzeddel RF, Schulz-Menger J. Cardiovascular magnetic resonance in adults with previous cardiovascular surgery. Eur Heart J Cardiovasc Imaging 2013; 15:235-48. [DOI: 10.1093/ehjci/jet138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Prodromo J, D'Ancona G, Amaducci A, Pilato M. Aortic Valve Repair for Aortic Insufficiency: A Review. J Cardiothorac Vasc Anesth 2012; 26:923-32. [DOI: 10.1053/j.jvca.2011.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Indexed: 11/11/2022]
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