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Frankel WC, Robinson JA, Roselli EE, Unai S, Tretter JT, Fuller S, Nelson JS, Ghobrial J, Svensson LG, Pettersson GB, Najm HK, Karamlou T. Lifetime Management of Adolescents and Young Adults with Congenital Aortic Valve Disease. Ann Thorac Surg 2024:S0003-4975(24)00461-2. [PMID: 38871162 DOI: 10.1016/j.athoracsur.2024.04.038] [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: 11/15/2023] [Revised: 03/26/2024] [Accepted: 04/24/2024] [Indexed: 06/15/2024]
Abstract
In this invited expert review, we focus on evolving lifetime management strategies for adolescents and young adults with congenital aortic valve disease, acknowledging that these patients often require multiple interventions during their lifetime. Our goal is to preserve the native aortic valve when feasible. Leveraging advanced multimodality imaging, a detailed assessment of the aortic valve and root complex can be obtained, and a surgically approach tailored to an individual patient's anatomy and pathology can be used. In turn, aortic valve repair and reconstruction can be offered to a greater number of patients, either as a definitive strategy or as a component of a staged strategy to delay the need for aortic valve replacement until later in life when more options are available.
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Affiliation(s)
- William C Frankel
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin A Robinson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin T Tretter
- Department of Pediatric Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer S Nelson
- Division of Cardiovascular Surgery, Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, Florida
| | - Joanna Ghobrial
- Department of Pediatric Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hani K Najm
- Division of Pediatric Cardiac Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio.
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Notenboom ML, Schuermans A, Etnel JRG, Veen KM, van de Woestijne PC, Rega FR, Helbing WA, Bogers AJJC, Takkenberg JJM. Paediatric aortic valve replacement: a meta-analysis and microsimulation study. Eur Heart J 2023; 44:3231-3246. [PMID: 37366156 PMCID: PMC10482570 DOI: 10.1093/eurheartj/ehad370] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/21/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
AIMS To support decision-making in children undergoing aortic valve replacement (AVR), by providing a comprehensive overview of published outcomes after paediatric AVR, and microsimulation-based age-specific estimates of outcome with different valve substitutes. METHODS AND RESULTS A systematic review of published literature reporting clinical outcome after paediatric AVR (mean age <18 years) published between 1/1/1990 and 11/08/2021 was conducted. Publications reporting outcome after paediatric Ross procedure, mechanical AVR (mAVR), homograft AVR (hAVR), and/or bioprosthetic AVR were considered for inclusion. Early risks (<30d), late event rates (>30d) and time-to-event data were pooled and entered into a microsimulation model. Sixty-eight studies, of which one prospective and 67 retrospective cohort studies, were included, encompassing a total of 5259 patients (37 435 patient-years; median follow-up: 5.9 years; range 1-21 years). Pooled mean age for the Ross procedure, mAVR, and hAVR was 9.2 ± 5.6, 13.0 ± 3.4, and 8.4 ± 5.4 years, respectively. Pooled early mortality for the Ross procedure, mAVR, and hAVR was 3.7% (95% CI, 3.0%-4.7%), 7.0% (5.1%-9.6%), and 10.6% (6.6%-17.0%), respectively, and late mortality rate was 0.5%/year (0.4%-0.7%/year), 1.0%/year (0.6%-1.5%/year), and 1.4%/year (0.8%-2.5%/year), respectively. Microsimulation-based mean life-expectancy in the first 20 years was 18.9 years (18.6-19.1 years) after Ross (relative life-expectancy: 94.8%) and 17.0 years (16.5-17.6 years) after mAVR (relative life-expectancy: 86.3%). Microsimulation-based 20-year risk of aortic valve reintervention was 42.0% (95% CI: 39.6%-44.6%) after Ross and 17.8% (95% CI: 17.0%-19.4%) after mAVR. CONCLUSION Results of paediatric AVR are currently suboptimal with substantial mortality especially in the very young with considerable reintervention hazards for all valve substitutes, but the Ross procedure provides a survival benefit over mAVR. Pros and cons of substitutes should be carefully weighed during paediatric valve selection.
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Affiliation(s)
- Maximiliaan L Notenboom
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Zuid-Holland, The Netherlands
| | - Art Schuermans
- Department of Cardiac Surgery, University Hospitals Leuven, UZ Leuven Gasthuisberg, Herestraat 49, 3000, Leuven, Flanders, Belgium
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, 4th floor, Boston, MA 02129, USA
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Merkin Building, 415 Main St., Cambridge, MA 02142, USA
| | - Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Zuid-Holland, The Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Zuid-Holland, The Netherlands
| | - Pieter C van de Woestijne
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Zuid-Holland, The Netherlands
| | - Filip R Rega
- Department of Cardiac Surgery, University Hospitals Leuven, UZ Leuven Gasthuisberg, Herestraat 49, 3000, Leuven, Flanders, Belgium
| | - Willem A Helbing
- Department of Paediatrics, Division of Paediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, Zuid-Holland, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Zuid-Holland, The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Zuid-Holland, The Netherlands
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Haranal M, Sivalingam S. Aortic valve repair in the pediatric population: emerging role of aortic valve neocuspidization (AVNeo procedure). Indian J Thorac Cardiovasc Surg 2023; 39:262-270. [PMID: 37124595 PMCID: PMC10140244 DOI: 10.1007/s12055-023-01473-z] [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: 08/23/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/27/2023] Open
Abstract
Management of aortic valve diseases in children is challenging owing to the quality and quantity of the native tissue for repair, limitations in the currently available biological materials to supplement the repair and to achieve a long-lasting durable repair in an annulus where there is still growth potential. The aortic valve neocuspidization (AVNeo) procedure has emerged as a versatile alternative strategy in the armamentarium of pediatric aortic valve reconstructions that are currently available. In this review article, the focus of the discussion will be on the various aortic valve repair procedures in the pediatric population, with a special emphasis on the emerging role of AVNeo procedure in pediatrics and its outcomes.
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Affiliation(s)
- Maruti Haranal
- Department of Pediatric Cardiac Surgery, U N Mehta Institute of Cardiology and Research, Ahmedabad, Gujarat India
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Ren Q, Yu J, Chen T, Qiu H, Ji E, Liu T, Xu X, Cen J, Wen S, Zhuang J, Liu X. Long-term outcomes of primary aortic valve repair in children with congenital aortic stenosis - 15-year experience at a single center. Front Cardiovasc Med 2022; 9:1029245. [PMID: 36312277 PMCID: PMC9613358 DOI: 10.3389/fcvm.2022.1029245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Studies on the long-term outcomes of children with congenital aortic stenosis who underwent primary aortic repair are limited. We reviewed the long-term outcomes of children who underwent aortic valve (AoV) repair at our center. Methods All children (n = 75) who underwent AoV repair between 2006 and 2020 were reviewed. The Kaplan-Meier curve was used to demonstrate the survival estimates. The Cox proportional hazard model and competing risk regression model were used to identify risk factors for death, reintervention, adverse events, and replacement. Results The median age at surgery was 1.8 (IQR, 0.2–7.7) years, and the median weight at surgery was 10.0 (IQR, 5.0–24.0) kg. Early mortality and late mortality were 5.3% (4/75) and 5.6% (4/71), respectively. Risk factors for overall mortality were concomitant mitral stenosis (P = 0.01, HR: 9.8, 95% CI: 1.8–53.9), low AoV annulus Z-score (P = 0.01, HR: 0.6, 95% CI: 0.4–0.9), and prolonged cardiopulmonary bypass time (P < 0.01, HR: 9.5, 95% CI: 1.7–52.1). Freedom from reintervention was 72.9 ± 0.10% (95% CI: 56.3–94.4%) at 10 years. Risk factors for occurrence of adverse event on multivariable analysis included preoperative intubation (P = 0.016, HR: 1.004, 95% CI: 1.001–1.007) and a low AoV annulus Z-score (P = 0.019, HR: 0.714, 95% CI: 0.540–0.945). Tricuspid AoV morphology was associated with a suboptimal postoperative outcome (P = 0.03). Conclusion Aortic valve repair remains a safe and durable solution for children with congenital aortic stenosis. Concomitant mitral stenosis and aortic valve anatomy, including tricuspid valve morphology and smaller annulus size, are associated with poor early and long-term outcomes.
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Affiliation(s)
- Qiushi Ren
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,School of Medicine, South China University of Technology, Guangzhou, China
| | - Juemin Yu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,School of Medicine, South China University of Technology, Guangzhou, China
| | - Tianyu Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hailong Qiu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Erchao Ji
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tao Liu
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, United States
| | - Xiaowei Xu
- Laboratory of Artificial Intelligence and 3D Technologies for Cardiovascular Diseases, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianzheng Cen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shusheng Wen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,*Correspondence: Xiaobing Liu,
| | - Xiaobing Liu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Jian Zhuang,
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Sengupta A, Beroukhim R, Baird CW, Del Nido PJ, Geva T, Gauvreau K, Marcus E, Sanders SP, Nathan M. Outcomes of Repair of Congenital Aortic Valve Lesions Using Autologous Pericardium vs Porcine Intestinal Submucosa. J Am Coll Cardiol 2022; 80:1060-1068. [PMID: 36075675 DOI: 10.1016/j.jacc.2022.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/11/2022] [Accepted: 06/21/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Outcomes following congenital aortic valve (AoV) repair are plagued by progressive dysfunction of currently available leaflet substitute materials. OBJECTIVES We compared the long-term outcomes of congenital AoV repair using porcine intestinal submucosa vs autologous pericardium (AP). METHODS This was a single-center retrospective review of all patients who underwent congenital AoV repair with either porcine intestinal submucosa or AP from October 2009 to March 2013. The primary outcome was postdischarge (late) unplanned AoV reintervention. Secondary outcomes included number of late AoV reinterventions and a composite of at least moderate aortic regurgitation or stenosis at latest follow-up or before the first reintervention. Associations between leaflet repair material and outcomes were assessed using multivariable regression models, adjusting for prespecified patient-related and operative variables. RESULTS Of 26 porcine intestinal submucosa and 49 AP patients who met entry criteria, the median age was 11.0 years (IQR: 4.7-16.6 years). At a median follow-up of 8.5 years (IQR: 4.4-9.6 years), 17 (65.4%) porcine intestinal submucosa and 22 (44.9%) AP patients underwent at least 1 AoV reintervention. On multivariable analysis, porcine intestinal submucosa use was significantly associated with unplanned AoV reintervention (HR: 4.6; 95% CI: 2.2-9.8; P < 0.001), number of postdischarge AoV reinterventions (incidence rate ratio: 1.7; 95% CI: 1.0-2.9; P = 0.037), and at least moderate aortic regurgitation or stenosis at latest follow-up or before the first reintervention (OR: 5.0; 95% CI: 1.2-21.0; P = 0.027). CONCLUSIONS Aortic valvuloplasty with porcine intestinal submucosa is associated with earlier time to reintervention compared with autologous pericardium. The search for the ideal AoV leaflet repair material continues.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
| | - Rebecca Beroukhim
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Edward Marcus
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Stephen P Sanders
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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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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Moscoso B, Randanne P, Zuccarino F, Congiu S, Mayol J, Caffarena JM. El talón de Aquiles del switch arterial: reparación de la neoválvula aórtica. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Long-term outcomes of primary aortic valve repair for isolated congenital aortic stenosis in children. J Thorac Cardiovasc Surg 2022; 164:1263-1274.e1. [DOI: 10.1016/j.jtcvs.2021.11.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/29/2021] [Accepted: 11/08/2021] [Indexed: 11/21/2022]
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Shin HJ, Min J, Kwak YJ, Lee JH, Kwon HW, Cho S, Kwak JG, Kim WH. Aortic Valve Repair in Young Patients: A Single Patch Design for Leaflet Extension. Pediatr Cardiol 2022; 43:164-170. [PMID: 34455453 DOI: 10.1007/s00246-021-02709-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
The surgical treatment for young patients with aortic valve diseases has not been standardized because of differences in the patients' growth. We aimed to investigate short-term results of aortic valve repair with leaflet extension techniques. From October 2017 to June 2020, we performed aortic valve repair with leaflet extension technique in 15 consecutive patients with a median age of 13 years (range, 33 months-27 years). Among them, all had moderate or severe aortic regurgitation (AR), eight had concomitant aortic stenosis, and 12 underwent prior cardiac operations. The leaflet patch design has been modified from separate patch design to single patch design. No early and late deaths were reported, no re-operations were performed, and temporary ectopic atrial arrhythmia was the only early complication noted. The patients were discharged with less than moderate AR after a median postoperative period of 5 (range, 3-7) days. All the patients were New York Heart Association class I after a median follow-up period of 17.3 (range, 4.4-34.6) months. However, two patients progressed to moderate AR postoperatively at 6 and 30 months, respectively, after which one was treated with single patch technique. Among the remaining patients, six had trace, six had mild, and one had mild-to-moderate AR. Aortic valve repair with leaflet extension is acceptable in young patients. Our single patch design was easy to manipulate and showed good short-term results. Long-term follow-up is required to further confirm the efficacy of this technique.
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Affiliation(s)
- Hong Ju Shin
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine Ansan, Ansan, South Korea
| | - Jooncheol Min
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Yu Jin Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Jae Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Hye Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, South Korea.
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Alsoufi B, Knight JH, St. Louis J, Raghuveer G, Kochilas L. Are Mechanical Prostheses Valid Alternatives to the Ross Procedure in Young Children Under 6 Years Old? Ann Thorac Surg 2022; 113:166-173. [PMID: 33359723 PMCID: PMC8219808 DOI: 10.1016/j.athoracsur.2020.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Aortic valve replacement in young children is associated with technical difficulties and potential morbidity. In contrast to the versatile Ross operation, mechanical prostheses (MP) are uncommonly used. METHODS We examined transplant-free survival and cardiac reoperation among 124 young children (aged 1-6 years) who underwent the Ross operation (n = 84) or MP (n = 40) for congenital disease (1982-2003) using the Pediatric Cardiac Care Consortium database. We explored variables influencing outcomes. RESULTS Children who received MP were operated in an earlier era and were more likely to have aortic regurgitation, conotruncal abnormalities, prior aortic valve surgery, and to need Konno annular enlargement. Although no significant differences were found in hospital mortality (1.2% vs 5.0%, P = .24) or 15-year transplant-free survival (94.1% vs 87.5%, P = .16) between Ross and MP recipients, survival diverged with later follow-up (91.3% vs 68.9%, respectively, at 25 years; P = .01). On multivariable regression analysis the association of MP use and transplant-free survival changed over time (hazard ratios, 0.8 [95% confidence interval, 0.1-4.4; P = .78] vs 6.0 [95% confidence interval, 0.6-63.1; P = .13], respectively) before and after 17 years. Cumulative incidence of cardiac reoperation at 10 years was 37.7% and 53.6% after the Ross procedure and MP, respectively (P = .05). The most common reoperation after the Ross procedure was conduit replacement and pacemaker ± automated internal cardiac defibrillator and after MP was pacemaker ± automated internal cardiac defibrillator and redo aortic valve replacement. CONCLUSIONS Over the study period there was a trend for increased Ross utilization. Interestingly MP use was associated with comparable operative mortality and survival up to 17 years, albeit with higher need for redo aortic valve replacement. On longer follow-up survival diverged with increased attrition in the MP group, likely because of late valve- and reoperation-related complications.
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Affiliation(s)
| | - Jessica H. Knight
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health
| | - James St. Louis
- Department of Pediatrics, University of Missouri-Kansas City
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Hu K, Siddiqi U, Lee B, Pena E, Schulz K, Vogel M, Combs P, El-Zein C, Ilbawi M, Vricella L, Hibino N. Pediatric aortic valve repair: Any development in the material for cusp extension valvuloplasty? J Card Surg 2021; 36:4054-4060. [PMID: 34423475 DOI: 10.1111/jocs.15931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aortic cusp extension is a technique for aortic valve (AV) repairs in pediatric patients. The choice of the material used in this procedure may influence the time before reoperation is required. We aimed to assess postoperative and long-term outcomes of patients receiving either pericardial or synthetic repairs. METHODS We conducted a single-center, retrospective study of pediatric patients undergoing aortic cusp extension valvuloplasty (N = 38) with either autologous pericardium (n = 30) or CorMatrix (n = 8) between April 2009 and July 2016. Short- and long-term postoperative outcomes were compared between the two groups. Freedom from reoperation was compared using Kaplan-Meier analysis. Degree of aortic stenosis (AS) and aortic regurgitation (AR) were recorded at baseline, postoperatively, and at outpatient follow-up. RESULTS At 5 years after repair, freedom from reoperation was significantly lower in the CorMatrix group (12.5%) compared to the pericardium group (62.5%) (p = .01). For the entire cohort, there was a statistically significant decrease in the peak trans-valvar gradient between preoperative and postoperative assessments with no significant change at outpatient follow-up. In the pericardium group, 28 (93%) had moderate to severe AR at baseline which improved to 11 (37%) postoperatively and increased to 21 (70%) at time of follow-up. In the biomaterial group, eight (100%) had moderate to severe AR which improved to three (38%) postoperatively and increased to seven (88%) at time of follow-up. CONCLUSION In terms of durability, the traditional autologous pericardium may outperform the new CorMatrix for AV repairs using the cusp extension method.
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Affiliation(s)
- Kelli Hu
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Umar Siddiqi
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Brian Lee
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Emily Pena
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Kelci Schulz
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Maggie Vogel
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Pamela Combs
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Chawki El-Zein
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Michel Ilbawi
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Luca Vricella
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Narutoshi Hibino
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
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12
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Danial P, Neily A, Pontailler M, Gaudin R, Khraiche D, Osborne-Pellegrin M, Vouhe P, Raisky O. Ross procedure or complex aortic valve repair using pericardium in children: A real dilemma. J Thorac Cardiovasc Surg 2021; 163:1180-1191.e6. [PMID: 33820635 DOI: 10.1016/j.jtcvs.2021.02.093] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
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.
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Affiliation(s)
- Pichoy Danial
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France; Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Asma Neily
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France
| | - Margaux Pontailler
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France
| | - Régis Gaudin
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France
| | - Diala Khraiche
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France
| | - Mary Osborne-Pellegrin
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Pascal Vouhe
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France
| | - Olivier Raisky
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France.
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13
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Hraska V, Mitchell ME, Woods RK. Roadmap for Ross procedure: Staged strategy. J Thorac Cardiovasc Surg 2021; 163:379-382. [PMID: 33581898 DOI: 10.1016/j.jtcvs.2020.12.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Viktor Hraska
- Division of Pediatric Cardiothoracic Surgery, Herma Heart Institute at Children's Wisconsin, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis.
| | - Michael E Mitchell
- Division of Pediatric Cardiothoracic Surgery, Herma Heart Institute at Children's Wisconsin, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis
| | - Ronald K Woods
- Division of Pediatric Cardiothoracic Surgery, Herma Heart Institute at Children's Wisconsin, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis
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14
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Yoneyama F, Matsubara M, Kato H, Tsukada T, Suetsugu F, Mathis BJ, Hiramatsu Y. Slit Orifice Aortic Cusp Extension Technique for Small Bicuspid Valves. Ann Thorac Surg 2020; 110:e143-e145. [PMID: 32247781 DOI: 10.1016/j.athoracsur.2020.02.055] [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: 12/16/2019] [Revised: 02/14/2020] [Accepted: 02/23/2020] [Indexed: 10/24/2022]
Abstract
We describe a modification to the aortic cusp extension technique that eliminates aortic regurgitation in pediatric small bicuspid valves. This simple and reproducible cusp extension technique secures coaptation and commissure suspension of the reconstructed aortic valve and may act as a bridge option for forthcoming reoperations.
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Affiliation(s)
- Fumiya Yoneyama
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan
| | - Muneaki Matsubara
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Kato
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan.
| | - Toru Tsukada
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan
| | - Fuminaga Suetsugu
- Department of Cardiovascular Surgery, Suetsugu Clinic, Fukuoka, Japan
| | - Bryan J Mathis
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Japan
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15
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Bell D, Betts K, Justo R, Forde N, Venugopal P, Corno AF, Smith P, Caputo M, Marsico R, Karl TR, Alphonso N. Multicenter Experience With 500 CardioCel Implants Used for the Repair of Congenital Heart Defects. Ann Thorac Surg 2019; 108:1883-1888. [DOI: 10.1016/j.athoracsur.2019.04.085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/14/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
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16
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Nordmeyer S, Kretzschmar J, Murin P, Cho MY, Foth R, Schlichting U, Berger F, Ovroutski S, Photiadis J, Sigler M. ADAPT-treated pericardium for aortic valve reconstruction in congenital heart disease: histological analysis of a series of human explants. Eur J Cardiothorac Surg 2019; 56:1170-1177. [DOI: 10.1093/ejcts/ezz228] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/26/2019] [Accepted: 07/15/2019] [Indexed: 12/22/2022] Open
Abstract
Abstract
OBJECTIVES
Different types of patch materials are used for aortic valve repair in children with congenital aortic valve disease to avoid early valve replacement. CardioCel© (Admedus, Toowong, QLD, Australia) consists of bovine pericardium treated with the ADAPT method (Admedus’ proprietary tissue engineering process).
METHODS
Our goal was to describe tissue reactions in 12 explanted aortic valve leaflet specimens (augmented or replaced with CardioCel patch material) (11 explanted surgically, 1 autopsy). Explantation was performed during reoperation after aortic valve repair, necessitated by aortic valve stenosis in 5, aortic valve insufficiency in 2, combined aortic valve lesions in 3 patients and endocarditis in 1 patient. One patient died of sudden left heart failure 28 months after aortic valve repair. At the last documented follow-up of this patient at 22 months, he showed mild aortic valve stenosis and insufficiency. Implantation time (time between implantation and explantation) of CardioCel patches was a median of 25 (range 11–47) months. Explants were examined using a uniform protocol with methylmethacrylate and/or paraffin embedding after fixation in formalin. Besides standard histological staining, von Kossa (for identification of calcifications) and immunohistochemical stains were applied with antibodies specific for muscular, inflammatory and connective tissue component antigens. Findings regarding the extent of appositional growth on top of the patch consisting of fibroblasts and extracellular matrix components, calcification, and inflammation were rated using a 4-grade scale (G0 no/G1 few/G2 moderate/G3 massive).
RESULTS
Superficial endothelialization was demonstrated in all patients by immunohistochemical analysis. Nine specimens showed mild inflammatory cell infiltration (G1) (G2: n = 3). Significant appositional growth on top of the patch due to addition of fibroblasts and extracellular matrix components, was seen in all specimens (G1: n = 1; G2: n = 7; G3: n = 4). Ten of 12 samples with implant times of 23 months or longer revealed calcifications (G1: n = 6; G2: n = 3; G3: n = 1). Two specimens with the shortest implant times (11 and 20 months) showed no calcifications (G0). Thrombus apposition with granulocyte infiltration was demonstrated in the specimen of the patient with endocarditis.
CONCLUSIONS
In our cohort, all CardioCel patches used for aortic valve repair in patients with congenital heart disease demonstrated appositional growth of fibroblasts and extracellular matrix components, and calcification after an implant time of at least 23 months.
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Affiliation(s)
- Sarah Nordmeyer
- Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Johanna Kretzschmar
- Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Peter Murin
- Department of Surgery for Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Mi-Young Cho
- Department of Surgery for Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Rudi Foth
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Uwe Schlichting
- Department of Pathology, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Stanislav Ovroutski
- Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Joachim Photiadis
- Department of Surgery for Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
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Watanabe T, Nishigaki K, Kawahira Y, Kagisaki K. Successful Truncal Valve Replacement After Truncal Valve Repairs. Pediatr Cardiol 2019; 40:1314-1316. [PMID: 31152185 DOI: 10.1007/s00246-019-02126-y] [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: 03/25/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
The surgical management of severe truncal valvular dysfunction is still challenging in neonates with persistent truncus arteriosus. This report describes a 14-day-old neonate with severe truncal valve insufficiency successfully undergoing truncal valve repairs, and followed by valve replacement at the age of 4 years. The truncal valve was quadricuspid with two large and two small leaflets, and all leaflets had severe dysplastic and myxomatous changes. We performed leaflet extension and bicuspidization valvuloplasty for this valve. This patient obtained somatic growth for 4 years without heart failure symptoms, and safely underwent prosthetic valve replacement. This technique would be effective for truncal valve dysfunction in neonates as the life-saving and the bridging procedure to valve replacement.
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Affiliation(s)
- Takuji Watanabe
- Departments of Pediatric Cardiovascular Surgery, Osaka City General Hospital, 2-13-22, Miyakojimadori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Kyoichi Nishigaki
- Departments of Pediatric Cardiovascular Surgery, Osaka City General Hospital, 2-13-22, Miyakojimadori, Miyakojima-ku, Osaka, 534-0021, Japan.
| | - Yoichi Kawahira
- Departments of Pediatric Cardiovascular Surgery, Osaka City General Hospital, 2-13-22, Miyakojimadori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Koji Kagisaki
- Departments of Pediatric Cardiovascular Surgery, Osaka City General Hospital, 2-13-22, Miyakojimadori, Miyakojima-ku, Osaka, 534-0021, Japan
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18
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d'Udekem Y. Aortic valve repair in pediatrics-time to swing the pendulum back? Ann Cardiothorac Surg 2019; 8:396-398. [PMID: 31240185 DOI: 10.21037/acs.2019.04.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yves d'Udekem
- Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia
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19
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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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20
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Atik SU, Eroğlu AG, Çinar B, Bakar MT, Saltik İL. 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. [PMID: 29923134 DOI: 10.1007/s00246-018-1929-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/06/2018] [Indexed: 02/04/2023]
Abstract
The two main modalities used for congenital aortic valvular stenosis (AVS) treatment are balloon aortic valve dilatation (BAD) and surgical aortic valvuloplasty (SAV). This study evaluates residual and recurrent stenosis, aortic regurgitation (AR) development/progression, reintervention rates, and the risk factors associated with this end point in patients with non-critical congenital AVS who underwent BAD or SAV after up to 18 years of follow-up. From 1990 to 2017, 70 consecutive interventions were performed in patients with AVS, and 61 were included in this study (33 BADs and 28 SAVs). There were no significant differences in age, sex distribution, PSIG, and AR frequency between the BAD and SAV groups. Bicuspid valve morphology was more common in the BAD group than the SAV group. There was no statistically significant difference between PSIGs and AR development or progression after intervention at the immediate postoperative echocardiography of patients who underwent BAD or SAV (p = 0.82 vs. p = 0.29). Patients were followed 6.9 ± 5.1 years after intervention. The follow-up period in the SAV group was longer than that of the BAD group (9.5 ± 5.4 vs. 5.5 ± 4.4 years, p = 0.003). There was no statistically significant difference in the last echocardiographic PSIG between patients who underwent SAV or BAD (51.1 ± 33.5 vs. 57.3 ± 35.1, p = 0.659). Freedom from reintervention was 81.3% at 5 years and 57.5% at 10 years in the BAD group and 95.5% at 5 years and 81.8% at 10 years in the SAV group, respectively (p = 0.044). There was no difference in postprocedural immediate PSIG and last PSIG at follow-up and the development/progression of AR between patients who were treated with BAD versus SAV. However, long-term results of SAV were superior to those of BAD, with a somewhat prolonged reintervention interval.
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Affiliation(s)
- Sezen Ugan Atik
- Department of Pediatric Cardiology, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey.
| | - Ayşe Güler Eroğlu
- Department of Pediatric Cardiology, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Betül Çinar
- Department of Pediatrics, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Murat Tuğberk Bakar
- Department of Public Health, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - İrfan Levent Saltik
- Department of Pediatric Cardiology, İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
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21
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Nordmeyer S, Murin P, Schulz A, Danne F, Nordmeyer J, Kretzschmar J, Sumbadze D, Schmitt KRL, Miera O, Cho MY, Sinzobahamvya N, Berger F, Ovroutski S, Photiadis J. Results of aortic valve repair using decellularized bovine pericardium in congenital surgery. Eur J Cardiothorac Surg 2018; 54:986-992. [DOI: 10.1093/ejcts/ezy181] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/02/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah Nordmeyer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Murin
- Department of Surgery for Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Antonia Schulz
- Department of Surgery for Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Friederike Danne
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Johannes Nordmeyer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Johanna Kretzschmar
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Daria Sumbadze
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | | | - Oliver Miera
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Mi-Young Cho
- Department of Surgery for Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Nicodeme Sinzobahamvya
- Department of Surgery for Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Stanislav Ovroutski
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Joachim Photiadis
- Department of Surgery for Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
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22
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ElZein C, Roberson D, Hammad N, Ilbawi M. Aortic Valvuloplasty or Rootplasty for Aortic Regurgitation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2018; 21:33-40. [PMID: 29425523 DOI: 10.1053/j.pcsu.2017.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/13/2017] [Indexed: 06/08/2023]
Abstract
At present, aortic valvuloplasty is considered an effective procedure for treatment of aortic regurgitation in pediatric patients. It has encouraging mid- and long-term results. The improved outcome is primarily related to better understanding of the functional anatomy of the normal valve and the different factors that alter it. It is also related to the realization that outcome after valvuloplasty is dependent on comprehensive repair of all of the involved components of the aortic root. Refinement in preoperative diagnosis has helped identify these abnormal components and focus the surgical approach on the needed reconstruction. Although the technical aspects of valvuloplasty are well defined, suboptimal long-term results still occur in some cases because the patch material used for valve repair can become fibrotic or calcified. This review summarizes the surgical approach to and the management of the different abnormal root components in pediatric patients with significant aortic valve regurgitation.
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Affiliation(s)
- Chawki ElZein
- Division of Pediatric Cardiac Surgery, Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - David Roberson
- Pediatric Cardiology, Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Nour Hammad
- Division of Pediatric Cardiac Surgery, Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Michel Ilbawi
- Division of Pediatric Cardiac Surgery, Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois.
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Vergnat M, Asfour B, Arenz C, Suchowerskyj P, Bierbach B, Schindler E, Schneider M, Hraska V. Contemporary results of aortic valve repair for congenital disease: lessons for management and staged strategy†. Eur J Cardiothorac Surg 2017; 52:581-587. [DOI: 10.1093/ejcts/ezx172] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/19/2017] [Indexed: 11/14/2022] Open
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24
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Yangni-Angate KH, Meneas C, Diby F, Diomande M, Adoubi A, Tanauh Y. Cardiac surgery in Africa: a thirty-five year experience on open heart surgery in Cote d'Ivoire. Cardiovasc Diagn Ther 2016; 6:S44-S63. [PMID: 27904843 DOI: 10.21037/cdt.2016.10.06] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few centers for open heart surgery (OHS) are in Sub-Saharan Africa. Lack of OHS results is also noted. By reporting our African experience on OHS, the aim of this study was to fill the gap. METHODS It is a retrospective study on 2,612 patients who were subject to an OHS between 1978 and 2013. Data were collected from demographical, clinical, investigative studies, surgical and outcomes parameters. RESULTS There were 1,475 cases of rheumatic heart diseases (RHD), 126 endomyocardial fibrosis (EMF), 741 congenital heart diseases (CHDs) and 270 various affections. Related to rheumatic valvular surgery we enumerated 1,175 monovalvular (mitral n=778, aortic n=336, tricuspid n=61); 280 bivalvular (mitral + aortic n=150, mitral + tricuspid n=130) and 20 trivalvular. For RHD, average age was 26±10.1 years (4-69 years) and 60% of our patients presented a functional class III or IV according to New York Heart Association (NYHA) classification. A total of 1,481 valvular replacements (bioprostheses n=489, mechanical prostheses n=992) and 445 valvular repair were carried out with a global and late mortality surgery respectively at 7% and 8%. One hundred and twenty-six [126] cases of EMF with right sided form 39, left sided form 40, and bilateral form 47 were colligated. Average age was 12±0.6 years (2-15 years). All patients with EMF underwent surgery; an endocardectomy in all patients combined with valvular reconstruction (n=36) or valvular replacement (n=90) was carried out with a hospital mortality at 16% (n=20). Concerning CHD, the most frequent were ventricular septal defect (VSD) (n=240), atrial septal defect (ASD) (n=200), partial atrio-ventricular sepal defect (n=30) and tetralogy of Fallot (T4F) (n=220), a total correction was performed for those CHD with an early mortality at 6.4% (n=44). CONCLUSIONS OHS in Cote d'Ivoire was successfully performed in most of our patients, the spectrum of acquired valvular heart diseases and CHDs in our country is similar to others in Sub-Saharan Africa.
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Affiliation(s)
- Koffi Herve Yangni-Angate
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Christophe Meneas
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Florent Diby
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Manga Diomande
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire
| | - Anicet Adoubi
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Yves Tanauh
- Department of Thoracic Surgery, Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
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25
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Donald JS, Konstantinov IE. Surgical Aortic Valvuloplasty Versus Balloon Aortic Valve Dilatation in Children. World J Pediatr Congenit Heart Surg 2016; 7:583-91. [DOI: 10.1177/2150135116651091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/17/2016] [Indexed: 11/15/2022]
Abstract
Balloon aortic valve dilatation (BAD) is assumed to provide the same outcomes as surgical aortic valvuloplasty (SAV). However, the development of precise modern surgical valvuloplasty techniques may result in better long-term durability of the aortic valve repair. This review of the recent literature suggests that current SAV provides a safe and durable repair. Furthermore, primary SAV appears to have greater freedom from reintervention and aortic valve replacement when compared to BAD.
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Affiliation(s)
- Julia S. Donald
- Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, 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
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26
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Subramanian S, Tikhomirov V, Bharati S, ElZein C, Roberson D, Ilbawi MN. Relationship of Normal Aortic Valve Cusp Dimensions: A Tool to Optimize Cusp Reconstruction Valvuloplasty. Semin Thorac Cardiovasc Surg 2016; 28:521-527. [DOI: 10.1053/j.semtcvs.2015.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2015] [Indexed: 11/11/2022]
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Aguilar-Jiménez JM, García-Torres E, Arlati FG, Vera-Puente F, Comas-Íllas JV. Conversión de una válvula aórtica bicúspide en tricúspide. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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d'Udekem Y, Sharma V. Repair options in rheumatic aortic valve disease in young patients: potential problems with pericardial cusp extension. World J Pediatr Congenit Heart Surg 2014; 4:392-6. [PMID: 24327633 DOI: 10.1177/2150135113496440] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article outlines the arguments against cusp extension, which were put forward at the debate entitled "Repair options in rheumatic aortic disease in young patients" at the Symposium on Surgery for Rheumatic Heart Disease organized by The World Society for Pediatric and Congenital Heart Surgery at The Sixth World Congress of Paediatric Cardiology and Cardiac Surgery, February 17-22, 2013, Cape Town, South Africa. We propose that cusp extension should be avoided because (1) these patients are usually old enough to receive the same valve substitutes as adults, (2) lack of antibioprophylaxis compliance will likely result in early reintervention, (3) cusp extension mandates rerepair within four to five years and is more expensive in the long term, and (4) it is fraught with myocardial ischemic complications. Thus, a mechanical, bioprosthetic, or autograft valve replacement may be superior for patients unless they have unrestricted access to repetitive interventions. A single surgical technique does not suffice in the treatment of rheumatic aortic valve disease, and a diversified approach should be adopted dependent on both the patients' characteristics and the financial constraints.
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Affiliation(s)
- Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
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In vitro study of a standardized approach to aortic cusp extension. Int J Artif Organs 2014; 37:315-24. [PMID: 24811186 DOI: 10.5301/ijao.5000316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE Cusp extension technique (CET) is a reparative surgical procedure for restoring aortic valve function by suturing patches to the compromised native leaflets. Its outcomes are strongly dependent on the ability of the surgeon. We proposed and tested a novel approach on an in vitro model, aimed at standardizing and simplifying the surgical procedure. METHODS A set of standard pre-cut bovine pericardium patches, available in different sizes, was developed. The surgeon can choose the leaflet-specific patches to be implanted according to the patient anatomy, using a geometrical model of the aortic valve whose inputs are the measured intercommissural distances. The hemodynamic performance of this approach was evaluated on porcine aortic roots in a pulsatile mock loop. Hydrodynamic and kinematic evaluation of the samples was provided. RESULTS After CET, mean and maximum pressure drops were 3.1±1.3 mmHg and 25.4±5.0 mmHg respectively, and EOA was 3.8±0.8 cm. CONCLUSIONS Our approach to cusp extension proved to be reliable and effective in restoring valve functioning, without significantly altering the physiological kinematics. The use of pre-cut patches considerably simplified the surgery, increasing standardization and repeatability.
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Mosala Nezhad Z, de Kerchove L, Hechadi J, Tamer S, Boodhwani M, Poncelet A, Noirhomme P, Rubay J, El Khoury G. Aortic valve repair with patch in non-rheumatic disease: indication, techniques and durability†. Eur J Cardiothorac Surg 2014; 46:997-1005; discussion 1005. [PMID: 24618389 DOI: 10.1093/ejcts/ezu058] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To analyse the long-term outcomes of aortic valve (AV) repair with biological patch in patient with non-rheumatic valve disease. METHODS From 1995 to 2011, 554 patients underwent elective (AV) repair; among them, 57 (mean age 45 ± 17 years) had cusp restoration using patch for non-rheumatic valve disease. Seven (12%) patients had unicuspid valve, 30 (53%) patients had bicuspid valve and 20 (35%) had tricuspid valve. Autologous pericardium was used in 26 patients (7 treated, 19 non-treated), bovine pericardium in 26, autologous tricuspid valve leaflet in 4 and aortic homograft cusp in 1. Patching was used to repair perforation (n = 20, 35%), commissural defect (n = 18, 32%), raphe repair (n = 17, 30%) or for cusp extension (n = 2, 3.5%). Echocardiographic and clinical follow-up was 98% complete and mean follow-up was 72 ± 42.5 months. RESULTS No hospital mortality. At 8 years, overall survival was 90 ± 5% and freedom from valve-related death was 96 ± 3%. Two patients (3.5%) needed early reoperation for aortic regurgitation (AR); they underwent re-repair and the Ross procedure, respectively. Late reoperation was necessary in 9 patients (16%) for AR (n = 4), stenosis (n = 3) or mixed disease (n = 2). They had the Ross procedure (n = 6) or prosthetic valve replacement (n = 3) with no mortality. At 8 years, freedom from reoperation was 75 ± 9%. Freedom from reoperation was slightly higher in tricuspid compared with non-tricuspid valves (92 ± 7 vs 68 ± 11%, P = 0.18) and slightly higher for bovine (95 ± 5%) compared with autologous pericardium (73 ± 11%, P = 0.38), but differences were statistically not significant. In tricuspid valves, freedom from reoperation was higher in perforation repair compared with other techniques (100 vs 50 ± 35%, P = 0.02). In bicuspid valves, freedom from reoperation was similar between different repair techniques (P = 0.38). Late echocardiography showed AR 0-1 in 30 (53%) patients, AR 2 in 12 (21%) and no AR ≥ 3. Three patients presented a mean transvalvular gradient of 30-40 mmHg. Thromboembolic events occurred in 2 patients (0.6%/patient-year), bleeding events in 1 (0.3% /patient-year) and no endocarditis occurred. CONCLUSIONS AV repair with biological patch is feasible for various aetiologies. The techniques are safe and medium-term durability is acceptable, even excellent for perforation repair in tricuspid valve morphology. Bovine pericardium is a good alternative to autologous pericardium.
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Affiliation(s)
- Zahra Mosala Nezhad
- Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laurent de Kerchove
- Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jawad Hechadi
- Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Saadallah Tamer
- Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Alain Poncelet
- Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Philippe Noirhomme
- Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jean Rubay
- Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gebrine El Khoury
- Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Alsoufi B. Aortic and mitral valve replacement in children: current options and outcomes. Expert Rev Cardiovasc Ther 2014; 9:805-9. [DOI: 10.1586/erc.11.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Alsoufi B, d‘Udekem Y. Aortic valve repair and replacement in children. Future Cardiol 2014; 10:105-15. [DOI: 10.2217/fca.13.88] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT: Several aortic valve (AV) pathologies might necessitate intervention. Percutaneous or surgical AV repair is generally recommended as the initial management strategy in children with AV disease, offering the advantage of stabilization of the heart dimensions and improvement of patients‘ symptoms. When AV repair is not possible or fails, AV replacement is necessary and is associated with several challenges in children. This review will focus on treatment strategy, AV repair techniques, AV replacement choices and outcomes of AV disease management in children.
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Affiliation(s)
- Bahaaldin Alsoufi
- Division of Cardiothoracic Surgery, Department of Surgery, Children‘s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Yves d‘Udekem
- Department of Cardiac Surgery, Royal Children‘s Hospital, Melbourne, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, Melbourne, Australia
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Matsuhisa H, Oshima Y, Tanaka A, Kamei N. Mini-Konno procedure using a 10 mm handmade valve for pulmonary atresia with intact ventricular septum and severe aortic stenosis. Interact Cardiovasc Thorac Surg 2013; 18:404-6. [PMID: 24336795 DOI: 10.1093/icvts/ivt519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We herein report the case of a neonate with pulmonary atresia with intact ventricular septum, right ventricular hypoplasia and severe aortic stenosis. Repetitive aortic valve surgeries in early infancy resulted in early relapse of the aortic stenosis due to the small aortic annulus, bicuspid configuration and duct-dependent pulmonary circulation. The infant underwent a successful mini-Konno procedure using a 10 mm handmade valve and bidirectional Glenn shunt at 6 months of age.
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Affiliation(s)
- Hironori Matsuhisa
- Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan
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Outcomes After Operations for Bicuspid Aortic Valve Disease in the Pediatric Population. Ann Thorac Surg 2013; 96:2175-83. [DOI: 10.1016/j.athoracsur.2013.07.130] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 12/20/2022]
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Alsoufi B. Aortic valve replacement in children: Options and outcomes. J Saudi Heart Assoc 2013; 26:33-41. [PMID: 24578598 DOI: 10.1016/j.jsha.2013.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 08/19/2013] [Accepted: 11/02/2013] [Indexed: 10/26/2022] Open
Abstract
Several disease pathologies such as congenital heart disease and rheumatic fever can affect the aortic valve (AV) in children frequently necessitating intervention. While percutaneous or surgical AV repair is recommended as initial management strategy in children with AV disease, AV replacement (AVR) might become necessary in children with significant valve destruction and after repair or intervention failure. AVR in children is associated with distinct clinical and technical problems owing to several anatomic, social and prosthesis-related issues. In the current review, we list different AV substitutes, discuss their advantages and shortcomings, outline AVR results in children, and explore the divergence of outcomes in various age, anatomy and pathology subgroups; all in the aim to identify optimal AVR choice for each patient taking into consideration his unique anatomic and demographic characteristics.
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Affiliation(s)
- Bahaaldin Alsoufi
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
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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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d'Udekem Y. Aortic valve repair in children. Ann Cardiothorac Surg 2013; 2:100-4. [PMID: 23977565 DOI: 10.3978/j.issn.2225-319x.2012.11.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/14/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; ; Department of Pediatrics of the University of Melbourne, and the Murdoch Children's Institute, Melbourne, Australia
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d'Udekem Y, Siddiqui J, Seaman CS, Konstantinov IE, Galati JC, Cheung MM, Brizard CP. Long-term results of a strategy of aortic valve repair in the pediatric population. J Thorac Cardiovasc Surg 2013; 145:461-7; discussion 467-9. [DOI: 10.1016/j.jtcvs.2012.11.033] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 09/14/2012] [Accepted: 11/09/2012] [Indexed: 12/01/2022]
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Vohra HA, deKerchove L, Rubay J, ElKhoury G. A simple technique of commissural reconstruction in aortic valve-sparing surgery. J Thorac Cardiovasc Surg 2012; 145:882-6. [PMID: 23228408 DOI: 10.1016/j.jtcvs.2012.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 10/04/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Hunaid A Vohra
- Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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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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Polimenakos AC, Sathanandam S, Blair C, Elzein C, Roberson D, Ilbawi MN. Selective tricuspidization and aortic cusp extension valvuloplasty: outcome analysis in infants and children. Ann Thorac Surg 2010; 90:839-46; discussion 846-7. [PMID: 20732505 DOI: 10.1016/j.athoracsur.2010.05.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 05/13/2010] [Accepted: 05/17/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Encouraging early outcomes of emerging aortic cusp extension valvuloplasty techniques have redirected attention to nonreplacement strategies in the management of younger patients with aortic insufficiency or aortic stenosis. Outcome analysis after aortic cusp extension valvuloplasty in infants and children was undertaken. METHODS From July 1987 to December 2008, 78 patients younger than 10 years of age underwent aortic cusp extension valvuloplasty in the form of pericardial cusp extension and selective use of tricuspidization. Sixteen (20.5%) patients were younger than 1 year of age. Twenty-seven had bicuspid aortic valve, 34, congenital aortic valve stenosis, and 17, congenital or acquired aortic insufficiency or aortic stenosis. Forty-two patients had balloon valvuloplasty or surgical valvotomy before aortic cusp extension valvuloplasty. Median follow-up was 12.4 years (range, 0.1 to 21.6 years). Freedom from aortic valve replacement (AVR) and determinants of outcome were analyzed. RESULTS There were no early or late deaths. During the follow-up period, 23 patients (29.5%) had Ross operation and 8 patients (10.2%) had other AVR. The z values of left ventricular end-diastolic dimension, aortic annulus, aortic sinus diameter, sinotubular junction diameter, and left ventricular wall thickness before AVR were 3.8 +/- 2.95, 2.1 +/- 1.15, 4.2 +/- 1.22, 1.78 +/- 1.24, and 2.92 +/- 1.31, respectively. Actuarial freedom from AVR at 1, 5, and 10 years was 97.3 +/- 2.0%, 71.3 +/- 5.8%, and 55.6 +/- 6.9%, respectively. CONCLUSIONS Aortic cusp extension valvuloplasty with tricuspidization allows left ventricular reverse remodeling with satisfactory long-term durability and freedom from AVR. Used selectively, it represents a reliable and effective approach in infants and children with congenital or acquired abnormal aortic valve.
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Affiliation(s)
- Anastasios C Polimenakos
- Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, Illinois, USA.
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