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Park I, Yang JH, Sung K, Jun TG, Kang IS, Huh J, Song JY, Park PW. Valve-sparing root replacement in children with connective tissue disease: Long-term risk of aortic events. J Thorac Cardiovasc Surg 2024; 168:182-192.e1. [PMID: 37890658 DOI: 10.1016/j.jtcvs.2023.10.041] [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: 07/25/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Cardiovascular involvement in pediatric patients with connective tissue disease (CTD) is life-threatening, with aortic root dilatation being the most prevalent cardiovascular abnormality. We attempted to determine long-term outcomes of valve-sparing root replacement (VSRR) in this group, including cardiovascular reoperations for aortic aneurysm and dissection. METHODS We conducted a retrospective analysis of pediatric patients with CTD who received VSRR in a single center from 2002 to 2021. The primary end point was a composite event of all-cause death and cardiovascular reoperations. The median follow-up duration was 8.3 years, with a maximum of 20.7 years. RESULTS The median age of 24 pediatric patients who had VSRR was 14.4 years. Marfan syndrome and Loeys-Dietz syndrome affected 19 (79.2%) and 5 (20.8%) patients, respectively. There was no early death. The 15-year survival rate was 91.7%. At 10 years after VSRR, the cumulative incidence of reoperation for aortic regurgitation was 15.6%, and for aortic aneurysm or dissection, it was 29.1%. The 10-year rate of freedom from the primary end point was 53.1%. The Cox multivariable analysis revealed younger age at surgery (hazard ratio, 1.279; 95% confidence interval, 1.086-1.505; P = .003) and VSRR before 13 years of age (hazard ratio, 5.005; 95% confidence interval, 1.146-21.850; P = .032) as independent prognostic factors for the primary endpoint. CONCLUSIONS VSRR for aortic root dilatation in pediatric patients with CTD demonstrated good long-term survival and low reoperation rates for aortic regurgitation. However, several patients developed later aortic aneurysm or dissection, and careful surveillance may be required, particularly in those who received VSRR at younger age.
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Affiliation(s)
- Ilkun Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Hyuk Yang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - I-Seok Kang
- Department of Pediatrics, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - June Huh
- Department of Pediatrics, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Young Song
- Department of Pediatrics, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Incheon Sejong Hospital, Incheon, Gyeonggi-do, Republic of Korea
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Agematsu K, Nagashima M, Nishimura Y. Persistent neo-aortic root dilatation and aortic valve insufficiency after arterial switch operation following prior pulmonary artery banding. Indian J Thorac Cardiovasc Surg 2024; 40:107-110. [PMID: 38125325 PMCID: PMC10728024 DOI: 10.1007/s12055-023-01629-x] [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: 07/21/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 12/23/2023] Open
Abstract
Although there have been great improvements in the short- and medium-term outcomes of the arterial switch operation (ASO) for transposition of the great arteries (TGA), some complications including pulmonary artery stenosis, aortic valve insufficiency, and aortic root dilatation have also been reported. After ASO, the original pulmonary root and valve, which function in the systemic position as the neo-aortic root and valve respectively, are exposed to the systemic blood pressure, resulting in aortic root dilatation and valve insufficiency in some patients. One of the risk factors for these complications is a history of prior pulmonary artery banding (PAB). Complex TGA anatomy, including transposition of the great arteries and ventricular septal defect (TGA-VSD) or double outlet right ventricle and ventricular septal defect (DORV-VSD), is also an independent risk factor for neo-aortic dilatation and aortic valve regurgitation. Aortic valve and root replacement is sometime necessary for the patients with these pathologies long-term after ASO. Here, we present a patient who had persistent aortic sinus dilatation and aortic valve insufficiency since ASO and necessitating aortic root and valve replacement 15 years after ASO preceded by PAB. The patient underwent Bentall operation and his clinical course was favorable. Histological findings after root replacement revealed no remarkable structural difference between neo-aortic wall (originally pulmonary artery) and original aortic wall.
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Affiliation(s)
- Kota Agematsu
- Department of Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510 Japan
| | - Mitsugi Nagashima
- Department of Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510 Japan
| | - Yoshiharu Nishimura
- Department of Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510 Japan
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Shehata M, Bashir R, Al-Alao B, Salmasi MY, Asimakopoulos G, Hoschtitzky A. Type A aortic dissection following a tetralogy of Fallot repair. JTCVS Tech 2023; 22:145-146. [PMID: 38152233 PMCID: PMC10750883 DOI: 10.1016/j.xjtc.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Monicka Shehata
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Ryan Bashir
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Bassel Al-Alao
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | - M. Yousuf Salmasi
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | | | - Andreas Hoschtitzky
- Department of Congenital Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
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Konstantinov IE, Brizard CP, Buratto E. Congenital Aortic Valve Repair When the Options aren't Good: Truncus Arteriosus and Transposition of the Great Arteries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 26:56-62. [PMID: 36842799 DOI: 10.1053/j.pcsu.2022.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Patients with truncus arteriosus and transposition of great arteries are prone to neo-aortic valve insufficiency. Although presenting at opposite ends of the age spectrum, both conditions tend to be commonly associated with neo aortic root dilatation. In patients with truncus arteriosus there is an additional complexity of quadricuspid valve morphology, which make up the majority of valves requiring repair. A unified approach to all these patients would include reduction and stabilization of the annulus and sinotubular junction, as well as achieving equal and symmetrical coaptation of the valve leaflets. By systematically employing these techniques, valve replacement should be avoidable in most children.
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Affiliation(s)
- Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Victoria, Australia.
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Victoria, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne,Victoria, Australia
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5
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Estado del arte en la cirugía de reparación y reconstrucción valvular del paciente congénito. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hobbs RD, Schultz ML, Loney ML, Verma S, Xiong J, Ohye RG, Bove E, Si MS. Valve-Sparing Root Replacement After the Ross Procedure. J Thorac Cardiovasc Surg 2022; 165:251-259. [DOI: 10.1016/j.jtcvs.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
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Highlights in congenital cardiothoracic surgery: 2020-2021. J Thorac Cardiovasc Surg 2021; 162:349-352. [PMID: 34045057 DOI: 10.1016/j.jtcvs.2021.04.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 12/15/2022]
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Konstantinov IE, Backer CL, Yerebakan C, Alsoufi B. At the forefront of congenital cardiothoracic surgery: 2020-2021. J Thorac Cardiovasc Surg 2021; 162:178-182. [PMID: 33972113 DOI: 10.1016/j.jtcvs.2021.03.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Heart Research Group, Murdoch Children's Research Institute, Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
| | - Carl L Backer
- Section of Pediatric Cardiothoracic Surgery, UK HealthCare Kentucky Children's Hospital, Lexington, Ky; Heart Institute and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Can Yerebakan
- Cardiac Surgery, Children's National Heart Institute, Washington, DC
| | - Bahaaldin Alsoufi
- Department of Cardiothoracic Surgery, University of Louisville and Norton Children's Hospital, Louisville, Ky
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Mir A, Burkhart HM. Commentary: The role of valve-sparing aortic root surgery in congenital heart disease. J Thorac Cardiovasc Surg 2020; 162:965-966. [PMID: 33036745 DOI: 10.1016/j.jtcvs.2020.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Arshid Mir
- Section of Pediatric Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Harold M Burkhart
- Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla.
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Alsoufi B. Commentary: Complex aortic valve-sparing root operations in congenital heart disease: Are we unintentionally creating a monster? J Thorac Cardiovasc Surg 2020; 162:963-964. [PMID: 33640134 DOI: 10.1016/j.jtcvs.2020.09.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Ky.
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