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Peters MC, Kruithof BPT, Bouten CVC, Voets IK, van den Bogaerdt A, Goumans MJ, van Wijk A. Preservation of human heart valves for replacement in children with heart valve disease: past, present and future. Cell Tissue Bank 2024; 25:67-85. [PMID: 36725733 PMCID: PMC10902036 DOI: 10.1007/s10561-023-10076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/29/2023] [Indexed: 02/03/2023]
Abstract
Valvular heart disease affects 30% of the new-borns with congenital heart disease. Valve replacement of semilunar valves by mechanical, bioprosthetic or donor allograft valves is the main treatment approach. However, none of the replacements provides a viable valve that can grow and/or adapt with the growth of the child leading to re-operation throughout life. In this study, we review the impact of donor valve preservation on moving towards a more viable valve alternative for valve replacements in children or young adults.
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Affiliation(s)
- M C Peters
- Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3584 EA, Utrecht, The Netherlands.
- Department of Cardiovascular Cell Biology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands.
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands.
| | - B P T Kruithof
- Department of Cardiovascular Cell Biology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, The Netherlands
| | - C V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
| | - I K Voets
- Institute for Complex Molecular Systems, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
- Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
| | - A van den Bogaerdt
- Heart Valve Department, ETB-BISLIFE Multi Tissue Center, 2333 BD, Beverwijk, The Netherlands
| | - M J Goumans
- Department of Cardiovascular Cell Biology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - A van Wijk
- Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3584 EA, Utrecht, The Netherlands
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2
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Sengupta A, Gauvreau K, Marx GR, Colan SD, Newburger JW, Baird CW, Del Nido PJ, Nathan M. Residual Lesion Severity Predicts Midterm Outcomes After Congenital Aortic Valve Repair. Ann Thorac Surg 2023; 115:159-165. [PMID: 36075398 DOI: 10.1016/j.athoracsur.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/27/2022] [Accepted: 08/08/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND We sought to validate the technical performance score (TPS) as a predictor of midterm outcomes after congenital aortic valve repair. METHODS This was a single-center, retrospective review of consecutive patients who underwent aortic valve repair between January 1, 2011, and December 31, 2019. Predischarge echocardiograms were used to assign a TPS for each index operation as class 1, no aortic valve residua; class 2, minor aortic valve residua; or class 3, major aortic valve residua or predischarge reintervention for major residua. The primary outcome was postdischarge (late) unplanned aortic valve reintervention. Secondary outcomes included late mortality and at least moderate aortic regurgitation or stenosis at the latest follow-up or before the earliest reintervention. Associations between TPS and outcomes were assessed using competing risk, Cox proportional hazards, or logistic regression models, adjusting for preoperative patient- and procedure-related covariates. RESULTS Of 507 patients, there were 110 (21.7%) reinterventions, 22 (4.3%) deaths, and 67 (13.2%) cases of at least moderate aortic regurgitation or stenosis at the latest follow-up or earliest reintervention. On multivariable analysis, class 3 patients had a greater risk of reintervention (subdistribution hazard ratio, 2.6; 95% CI, 1.3-5.1; P = .005) and mortality (hazard ratio, 5.3; 95% CI. 1.1-25.2; P = .038) compared with class 1 patients. Adjusting for duration of follow-up, class 3 patients also had a greater risk of at least moderate aortic regurgitation or stenosis at the latest follow-up or earliest reintervention (odds ratio, 7.7; 95% CI, 2.5-24.2; P < .001) vs class 1 patients. CONCLUSIONS Patients with major residua after congenital aortic valve repair have significantly worse midterm outcomes compared with those with no residua, warranting closer follow-up.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Gerald R Marx
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts.
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Bouhout I, Kalfa D, Shah A, Goldstone AB, Harrington J, Bacha E. Surgical Management of Complex Aortic Valve Disease in Young Adults: Repair, Replacement, and Future Alternatives. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2022; 25:28-37. [PMID: 35835514 DOI: 10.1053/j.pcsu.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/17/2022] [Accepted: 04/29/2022] [Indexed: 11/11/2022]
Abstract
The ideal aortic valve substitute in young adults remains unknown. Prosthetic valves are associated with a suboptimal survival and carry a significant risk of valve-related complications in young patients, mainly reinterventions with tissue valves and, thromboembolic events and major bleeding with mechanical prostheses. The Ross procedure is the only substitute that restores a survival curve similar to that of a matched general population, and permits a normal life without functional limitations. Though the risk of reintervention is the Achilles' heel of this procedure, it is very low in patients with aortic stenosis and can be mitigated in patients with aortic regurgitation by tailored surgical techniques. Finally, the Ozaki procedure and the transcatheter aortic valve implantation are seen by many as future alternatives but lack evidence and long-term follow-up in this specific patient population.
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Affiliation(s)
- Ismail Bouhout
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - David Kalfa
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - Amee Shah
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, New York
| | - Andrew B Goldstone
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - Jamie Harrington
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, New York
| | - Emile Bacha
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York.
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Naimo PS, Bell D, Fricke TA, d'Udekem Y, Brizard CP, Alphonso N, Konstantinov IE. Truncus arteriosus repair: A 40-year multicenter perspective. J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)31137-5. [PMID: 32653289 DOI: 10.1016/j.jtcvs.2020.04.149] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 04/06/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the long-term surgical outcomes of patients who underwent truncus arteriosus (TA) repair. METHODS Between 1979 and 2018, a total of 255 patients underwent TA repair at 3 Australian hospitals. Data were obtained by review of medical records from initial admission until last cardiology follow-up. RESULTS At the time of TA repair, the median patient age was 44 days, and median weight was 3.5 kg. Early mortality was 13.3% (34 of 255), and overall survival was 76.8 ± 2.9% at 20 years. Neonatal surgery and low operative weight were risk factors for early mortality. Most deaths (82.5%; 47 of 57) occurred within the first year following repair. A coronary artery anomaly and early reoperation were identified as risk factors for late mortality. A total of 175 patients required at least 1 reoperation, with overall freedom of reoperation of 2.9 ± 1.5% at 20 years. Follow-up of survivors was 96% complete (191 of 198). The median duration of follow-up was 16.4 years. At the last follow-up, 190 patients were categorized as New York Heart Association class I/II, and 1 patient was class III. CONCLUSIONS TA repair during the neonatal period presents significant surgical challenges. Neonates with signs of overcirculation should be operated on promptly. A coronary artery anomaly is a risk factor for late mortality. Survival beyond the first year following repair is associated with excellent outcomes.
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Affiliation(s)
- Phillip S Naimo
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Douglas Bell
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Tyson A Fricke
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Melbourne's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
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Ivanov Y, Drury NE, Stickley J, Botha P, Khan NE, Jones TJ, Brawn WJ, Barron DJ. Strategies to Minimise Need for Prosthetic Aortic Valve Replacement in Congenital Aortic Stenosis—Value of the Ross Procedure. Semin Thorac Cardiovasc Surg 2020; 32:509-519. [DOI: 10.1053/j.semtcvs.2020.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 11/11/2022]
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Choi KH, Sung SC, Kim H, Lee HD, Ko H, Byun JH. The coronary reimplantation after neoaortic reconstruction technique can make a difference in arterial switch operation. J Cardiothorac Surg 2019; 14:166. [PMID: 31533768 PMCID: PMC6749680 DOI: 10.1186/s13019-019-0994-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to determine if there was a difference between coronary reimplantation after neoaortic reconstruction and open coronary reimplantation technique in arterial switch operation (ASO). METHODS A total of 236 patients who underwent ASO from March 1994 to August 2018 were enrolled in this study. Multivariate analysis was performed for postoperative early mortality. Patients were divided into the open coronary reimplantation and coronary reimplantation after neoaortic reconstruction groups. The 30-day mortality, intraoperative and postoperative coronary artery (CA) revisions, CA-related late morbidity and mortality, and early and late neoaortic valve regurgitations after ASO were compared between the two groups. RESULTS Overall postoperative early mortality was 7.2% (17/236). Patients who underwent open coronary reimplantation had higher early mortality as compared with those who underwent coronary reimplantation after neoaortic reconstruction. Risk factors for postoperative early mortality from multivariate analysis were cardiopulmonary bypass time and open coronary reimplantation. There was a higher incidence of CA-related late mortality or morbidity in the open coronary reimplantation group. The open coronary reimplantation group had a higher incidence of intraoperative or postoperative CA revision. There were no differences in the incidence of mild or more neoaortic valve regurgitation at discharge or in the 5-year freedom from mild or more neoaortic valve regurgitation. CONCLUSIONS CA reimplantation after neoaortic reconstruction yields better results in mortality and intraoperative or postoperative CA-related problems in ASO without increasing postoperative neoaortic valve regurgitation.
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Affiliation(s)
- Kwang Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, Geumo-ro 20, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, South Korea
| | - Si Chan Sung
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, Geumo-ro 20, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, South Korea.
| | - Hyungtae Kim
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, Geumo-ro 20, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, 50612, South Korea
| | - Hyoung Doo Lee
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, South Korea
| | - Hoon Ko
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, South Korea
| | - Joung-Hee Byun
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, South Korea
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Bouhout I, Ba PS, El-Hamamsy I, Poirier N. Aortic Valve Interventions in Pediatric Patients. Semin Thorac Cardiovasc Surg 2019; 31:277-287. [DOI: 10.1053/j.semtcvs.2018.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/26/2018] [Indexed: 11/11/2022]
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8
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Kandakure P, Prior N, Soda G, Lim J, Dhannapuneni R, Venugopal P, Alphonso N. Outcome of a Repair-Oriented Strategy for the Aortic Valve in Children. World J Pediatr Congenit Heart Surg 2014; 5:191-9. [DOI: 10.1177/2150135113513476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: We sought to evaluate the mid-term results of a repair-oriented strategy of the aortic valve in children. Methods: Between February 2007 and November 2011, we performed 39 aortic valve repairs in children. Median age and weight at surgery were 5.5 years (3 days-18 years) and 16.7 kg (2.7-83.5), respectively. A total of 11 (28%) patients had one or more prior surgical or interventional cardiologic procedures. Median intensive care unit and hospital stay were two (1-96) and five (3-96) days, respectively. Median and cumulative follow-up were 12.7 months (15 days-64 months) and 48.9 patient-years, respectively. Results: There were 3 (7.7%) early deaths all in patients undergoing additional complex cardiac procedures. Two (5.1%) patients required early surgical revision. Twenty-six (66%) patients had isolated or mixed aortic stenosis. The median gradient reduced from 62.4 (range 16-144) to 17.6 mm Hg (range 0-51.8), postoperatively ( P = .02). At last follow-up, the median gradient remained largely unchanged at 21.1 mm Hg (0-49; P = .02). Twenty-six (66%) patients had isolated or mixed aortic valve regurgitation (mild in 8 [20%], moderate in 15 [38%], and severe in 6 ([15%] patients). The degree of aortic regurgitation improved in all patients with moderate or severe aortic regurgitation ( P = .04). At last follow-up, two patients had moderate aortic regurgitation. Kaplan Meier freedom from reintervention in the survivors was 95% at three years. Conclusions: A repair-oriented strategy for the aortic valve in children has satisfactory early and mid-term results and remains a promising management option in children with aortic valve disease.
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Affiliation(s)
- Pramod Kandakure
- Cardiac Surgical Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Natasha Prior
- Cardiac Surgical Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Giri Soda
- Department of Cardiology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Joyce Lim
- Department of Cardiology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Ram Dhannapuneni
- Cardiac Surgical Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Prem Venugopal
- Cardiac Surgical Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Service, Mater Children’s Hospital, Raymond Terrace, South Brisbane 4101, Australia
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de Siena P, Ghorbel M, Chen Q, Yim D, Caputo M. Common arterial trunk: review of surgical strategies and future research. Expert Rev Cardiovasc Ther 2014; 9:1527-38. [DOI: 10.1586/erc.11.170] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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ElZein C, Subramanian S, Polimenakos AC, Roberson D, Ilbawi MN. Systematic Approach to Aortic Valvuloplasty in Children and Young Adults. World J Pediatr Congenit Heart Surg 2013; 4:412-7. [DOI: 10.1177/2150135113504598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Valve repair in children and young adults is an attractive alternative to replacement or Ross procedure. In the past, the various valvuloplasty techniques have addressed isolated valve pathology. Recently, however, a holistic approach involving repair of all aortic root structures has evolved and promised to be an excellent alternative to valve replacement. It provides good long-term results and avoids all the drawback of prosthetic valve insertion in this age group. Development of ideal patch material needed for valve repair and better understanding of the anatomy and function of the aortic root may further improve the short- and long-term outcomes of aortic valvuloplasty.
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Affiliation(s)
- Chawki ElZein
- Division of Pediatric Cardiology and Cardiac Surgery, Hope Children’s Hospital, Oak Lawn, IL, USA
- Division of Cardiothoracic Surgery, University of Illinois, IL, USA
| | - Sujata Subramanian
- Division of Pediatric Cardiology and Cardiac Surgery, Hope Children’s Hospital, Oak Lawn, IL, USA
- Division of Cardiothoracic Surgery, University of Illinois, IL, USA
| | - Anastasios C. Polimenakos
- Division of Pediatric Cardiology and Cardiac Surgery, Hope Children’s Hospital, Oak Lawn, IL, USA
- Division of Cardiothoracic Surgery, University of Illinois, IL, USA
| | - David Roberson
- Division of Pediatric Cardiology and Cardiac Surgery, Hope Children’s Hospital, Oak Lawn, IL, USA
- Division of Cardiothoracic Surgery, University of Illinois, IL, USA
| | - Michel N. Ilbawi
- Division of Pediatric Cardiology and Cardiac Surgery, Hope Children’s Hospital, Oak Lawn, IL, USA
- Division of Cardiothoracic Surgery, University of Illinois, IL, USA
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Bradley SM. Aortic Valve Insufficiency in the Teenager and Young Adult. World J Pediatr Congenit Heart Surg 2013; 4:397-402. [DOI: 10.1177/2150135113488781] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The contents of this article were presented in the session “Aortic insufficiency in the teenager” at the congenital parallel symposium of the 2013 Society of Thoracic Surgeons (STS) annual meeting. The accompanying articles detail the approaches of aortic valve repair and the Ross procedure.1,2 The current article focuses on prosthetic valve replacement. For many young patients requiring aortic valve surgery, either aortic valve repair or a Ross procedure provides a good option. The advantages include avoidance of anticoagulation and potential for growth. In other patients, a prosthetic valve is an appropriate alternative. This article discusses the current state of knowledge regarding mechanical and bioprosthetic valve prostheses and their specific advantages relative to valve repair or a Ross procedure. In current practice, young patients requiring aortic valve surgery frequently undergo valve replacement with a prosthetic valve. In STS adult cardiac database, among patients ≤30 years of age undergoing aortic valve surgery, 34% had placement of a mechanical valve, 51% had placement of a bioprosthetic valve, 9% had aortic valve repair, and 2% had a Ross procedure. In the STS congenital database, among patients 12 to 30 years of age undergoing aortic valve surgery, 21% had placement of a mechanical valve, 18% had placement of a bioprosthetic valve, 30% had aortic valve repair, and 24% had a Ross procedure. In the future, the balance among these options may be altered by design improvements in prosthetic valves, alternatives to warfarin, the development of new patch materials for valve repair, and techniques to avoid Ross autograft failure.
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Affiliation(s)
- Scott M. Bradley
- Pediatric Cardiac Surgery, Medical University of South Carolina, Charleston, SC, USA
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Fujiwara K, Imai K, Yoshizawa K, Ohno N, Sakazaki H, Tukuda K. Truncal valve repair using autologous pericardial patch augmentation. Asian Cardiovasc Thorac Ann 2013; 21:352-4. [DOI: 10.1177/0218492312454729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 35-month-old boy with severe truncal valve regurgitation underwent successful repair by tricuspidization using raphe slicing and an extension technique with glutaraldehyde-treated autologous pericardium. His truncal valve regurgitation improved from severe to mild 5 years postoperatively. Tricuspidization using raphe slicing and valve extension with autologous pericardium might be one of the alternatives for truncal valve regurgitation with a quadricuspid valve.
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Affiliation(s)
- Keiichi Fujiwara
- Department of Cardiovascular Surgery and Pediatric Cardiology, Heart Center, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
| | - Kenta Imai
- Department of Cardiovascular Surgery and Pediatric Cardiology, Heart Center, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
| | - Kohsuke Yoshizawa
- Department of Cardiovascular Surgery and Pediatric Cardiology, Heart Center, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery and Pediatric Cardiology, Heart Center, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
| | - Hisanori Sakazaki
- Department of Cardiovascular Surgery and Pediatric Cardiology, Heart Center, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
| | - Kazuya Tukuda
- Department of Cardiovascular Surgery and Pediatric Cardiology, Heart Center, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
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Myers PO, Bautista-Hernandez V, del Nido PJ, Marx GR, Mayer JE, Pigula FA, Baird CW. Surgical repair of truncal valve regurgitation†. Eur J Cardiothorac Surg 2013; 44:813-20. [DOI: 10.1093/ejcts/ezt213] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Perri G, Filippelli S, Polito A, Di Carlo D, Albanese SB, Carotti A. Repair of incompetent truncal valves: early and mid-term results. Interact Cardiovasc Thorac Surg 2013; 16:808-13. [PMID: 23487600 DOI: 10.1093/icvts/ivt098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To analyse the factors associated with in-hospital mortality and mid-term significant neoaortic valve regurgitation (AR) after truncal valve (TV) repair. METHODS Eleven children underwent TV repair at our institution from July 1999 to March 2012. All children presented significant preoperative TV regurgitation. Valve anatomy was quadricuspid in 7 (64%) patients and tricuspid in 4 (36%). The median age and weight at surgery were 29.6 (range 0.3-173.2) months and 12 (range 2.2-49) kg, respectively. Repair included bicuspidalization through the approximation of two leaflets associated with triangular resection of the opposite one (n = 2, 18%), or either bicuspidalization or tricuspidalization of the TV through excision of one leaflet and related sinus of Valsalva (n = 9, 82%). In 3 patients, repair was associated with coronary detachment before cusp removal, followed by coronary reimplantation. RESULTS In-hospital death occurred in 2 (18%) patients. Factors associated with hospital mortality were age <1 year (P = 0.05), weight <3 kg (P = 0.02) and longer cross-clamping time (P = 0.008). Follow-up was complete for all patients [median follow-up time: 52.2 (range 132.2-2.5) months]. Mid-term significant AR occurred in 4 patients (45%, moderate in 2 and severe in 2). One with severe AR underwent successful valve replacement 4 months postoperatively, leading to freedom from reintervention of 91%. Freedom from significant AR was 76.2 (33.2-93.5) and 60.9 (20.2-85.6) at 1 and 2 years, respectively. There was a trend towards longer freedom from mid-term significant AR for patients who underwent cusp removal compared with those who did not (P = 0.07). CONCLUSIONS TV repair in children can be performed safely with fairly good and durable results. Cusp removal might decrease the rate of severe AR on mid-term follow-up.
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Affiliation(s)
- Gianluigi Perri
- Unit of Cardiac Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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15
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Repair of Congenitally Dysplastic Aortic Valve by Bicuspidization: Midterm Results. Ann Thorac Surg 2012; 94:1173-9. [DOI: 10.1016/j.athoracsur.2012.04.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/12/2012] [Accepted: 04/16/2012] [Indexed: 01/18/2023]
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Baird CW, Myers PO, del Nido PJ. Aortic valve reconstruction in the young infants and children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2012; 15:9-19. [PMID: 22424502 DOI: 10.1053/j.pcsu.2012.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Considering the structure and function of the aortic root, changes in the aortic valve leaflets and changes in the geometry of the aortic root are the two primary causes of aortic valve dysfunction. In adults, aortic valve sparing reconstruction has a long history beginning in the 1970s, where tensor fascia was used for leaflet repair in patients with isolated aortic regurgitation and ascending aortic replacement was used in patients with ascending aortic aneurysms or aortic ectasia. Subsequent progress in the 1980s and 1990s led to pericardial leaflet replacement and aortic root re-implantation and remodeling. However, it has not been until the last decade that these concepts and techniques have been applied in younger patients focusing on the conotruncus, valvar apparatus, sino-tubular junction, and ascending aorta.
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Kaza AK, Burch PT, Pinto N, Minich LL, Tani LY, Hawkins JA. Durability of Truncal Valve Repair. Ann Thorac Surg 2010; 90:1307-12; discussion 1312. [DOI: 10.1016/j.athoracsur.2010.06.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 05/29/2010] [Accepted: 06/04/2010] [Indexed: 11/28/2022]
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Hawkins JA, Kaza AK, Burch PT, Lambert LM, Holubkov R, Witte MK. Simple Versus Complex Truncus Arteriosus. World J Pediatr Congenit Heart Surg 2010; 1:285-91. [DOI: 10.1177/2150135110381098] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined simple versus complex forms of truncus arteriosus (TA) results in the current era with regard to mortality, reintervention, and resource utilization. From 1999 to 2008, 42 infants underwent primary repair of TA, including 22 simple forms of TA without associated anomalies and 20 complex forms with risk factors such as interrupted aortic arch (n = 8), coarctation (n = 1), significant truncal valve regurgitation (n = 6), discontinuous pulmonary arteries (n = 3), and truncal valve stenosis (n = 2). There were 4 early deaths (4/42, 9.5%), with no difference between simple TA (2/22, 9.1%) and complex TA (2/20, 10%). Early mortality decreased to 1 patient (1/23, 4%) in the most recent era: 2003-2008. Late mortality occurred in 4 (4/38, 10.5%). Reintervention was required in 12 patients, a median of 2 years postoperatively: for conduit reasons in 8 and combined conduit and truncal valve insufficiency in 4. Actuarial survival was 82% ± 7% at 5 years and freedom from reintervention was 52% ± 17% at 5 years, which are not different between complex and simple forms. Complex TA, age, and weight were not predictors on multivariable analysis for early or late death or reintervention. Complex TA had significantly longer ( P < .05) median length of stay (17 vs 13 days) and intensive care unit intubation times (8 vs 5 days) versus simple TA. Complex TA does not have a higher operative or late mortality risk or increased risk of reintervention compared with simple TA. However, complex patients can be expected to have increased resource utilization as compared with simple forms of TA.
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Affiliation(s)
- John A. Hawkins
- Division of Pediatric Cardiothoracic Surgery, Primary Children’s Medical Center, Salt Lake City, UT, USA
| | - Aditya K. Kaza
- Division of Pediatric Cardiothoracic Surgery, Primary Children’s Medical Center, Salt Lake City, UT, USA
| | - Phillip T. Burch
- Division of Pediatric Cardiothoracic Surgery, Primary Children’s Medical Center, Salt Lake City, UT, USA
| | - Linda M. Lambert
- Division of Pediatric Cardiothoracic Surgery, Primary Children’s Medical Center, Salt Lake City, UT, USA
| | - Richard Holubkov
- Division of Pediatric Critical Care Medicine, Primary Children’s Medical Center, Salt Lake City, UT, USA
| | - Madolin K. Witte
- Division of Pediatric Critical Care Medicine, Primary Children’s Medical Center, Salt Lake City, UT, USA
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Michalak KW, Moll JA, Moll M, Młudzik K, Moll JJ. Neoaortic Valve Function 10 to 18 Years After Arterial Switch Operation. World J Pediatr Congenit Heart Surg 2010; 1:51-8. [DOI: 10.1177/2150135110361361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anatomical correction is a procedure of choice for transposition of the great arteries (TGA) in neonates. During surgery, the aorta and pulmonary artery are switched—the native pulmonary valve becomes the neoaortic valve. The fate of this valve remains uncertain. Many reports suggest that its ability to function worsens with time after surgery. Of 519 patients with TGA operated on between 1991 and 2008, 161 met inclusion criteria for this retrospective study and were followed 10 years or more to assess neoaortic valve regurgitation (NeoAR) occurrence and development and to estimate potential risk factors. The subjects were divided into 2 groups: group 1 (simple TGA) and group 2 (TGA + ventricle septal defect). Within the analyzed group, the frequency of significant regurgitation increased from 9% 1 year after the operation to 47% at the most recent follow-up. No severe regurgitation necessitating reoperation was observed. Analysis of potential risk factors revealed that pulmonary/aortic valve diameter discrepancy and nonfacing commissures were associated with increased risk of development of neoaortic insufficiency. NeoAR arises and develops over time after correction of the defect. No hemodynamic repercussions necessitating cardiac surgical interventions were observed. The majority of insufficiencies are detected between 2 and 6 years after surgery. The degree of incompetence is usually mild and increases during follow-up by about 0.5 or 1 degree. The risk factors for NeoAR appearance are pulmonary artery/aortic annulus discrepancy and nonfacing commissures.
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Affiliation(s)
| | - Jadwiga A. Moll
- Polish Mother’s Memorial Hospital, Research Institute, Łódź, Poland
| | - Maciej Moll
- Polish Mother’s Memorial Hospital, Research Institute, Łódź, Poland
| | | | - Jacek J. Moll
- Polish Mother’s Memorial Hospital, Research Institute, Łódź, Poland
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Izumoto H, Kawazoe K, Oka T, Ishibashi K, Yamamoto H, Yamamoto F. Leaflet Suspension and Subvalvular Annuloplasty in Aortic Valve Prolapse. Asian Cardiovasc Thorac Ann 2009; 17:278-81. [DOI: 10.1177/0218492309104773] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We have utilized the combined techniques of subvalvular annuloplasty and leaflet suspension since 1999 to repair prolapsing aortic valves. We reviewed our short-term results to assess perioperative echocardiographic changes and repair durability. Nineteen patients (15 men and 4 women; mean age, 60.7 years) underwent this operation between July 1999 and June 2002. All were interviewed to establish their latest functional status, reoperation and survival rates. After a mean follow-up of 40.1 months, all patients were alive and in New York Heart Association functional class I. The echocardiographic grade of aortic regurgitation decreased from 3.2 preoperatively to 1.6 at follow-up. Left ventricular end-diastolic dimension shortened significantly from 6.2 to 5.2 cm. Left ventricular end-systolic dimension decreased from 4.1 to 3.3 cm. Annulus size was also significantly less at 2.2 cm from 2.5 cm preoperatively. At 48 months, freedom from reoperation was 88.9% ± 7.4%. The follow-up was 100% complete. Repair of a prolapsing aortic valve with leaflet suspension and subvalvular annuloplasty is a good procedure and the short-term results are satisfying.
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Affiliation(s)
| | | | | | | | - Hiroshi Yamamoto
- Department of Cardiovascular Surgery Iwate Medical University Memorial Heart Center Morioka, Iwate, Japan
| | - Fumio Yamamoto
- Department of Cardiovascular Surgery Iwate Medical University Memorial Heart Center Morioka, Iwate, Japan
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Kaza AK, Hawkins JA. Aortic Valve Repair in Children, Including Pericardial Patch Reconstruction. ACTA ACUST UNITED AC 2009. [DOI: 10.1053/j.optechstcvs.2009.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bacha EA, McElhinney DB, Guleserian KJ, Colan SD, Jonas RA, del Nido PJ, Marx GR. 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; 135:552-9, 559.e1-3. [DOI: 10.1016/j.jtcvs.2007.09.057] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 09/11/2007] [Accepted: 09/26/2007] [Indexed: 11/29/2022]
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