Pediatric aortic valve repair: Any development in the material for cusp extension valvuloplasty?

State of the Art Review: Aortic Valve Repair in Infants and Children

BACKGROUND

Congenital aortic and truncal valve disease is challenging in infants and children given the lack of available prostheses in very small sizes and the limited durability of homograft aortic valve replacement.

METHODS

A comprehensive literature search was performed using the PubMed database. Studies were included either if the report included patients less than 1 year of age or if the technique was tailored to accommodate for somatic growth.

RESULTS

Techniques for aortic and truncal valve repair addressing each aspect of the aortic valve complex-the aorta, aortic annulus, commissures, and cusps-were reviewed. The incidence of reoperation after aortic or truncal valve repair is significant at 10 years and ranges from 30% to 70% depending on the underlying diagnosis and the repair technique used. A significant challenge in interpreting the published literature relates to the lack of anatomic data available in the publications, thus limiting both the ability to make direct comparisons among operative techniques and the ability to draw conclusions regarding these techniques as applied to varied causes.

CONCLUSIONS

A comprehensive understanding of the aortic valve complex is necessary to achieve adequate results in pediatric aortic valve repair given the high variability in these valves.

Outcomes of Repair of Congenital Aortic Valve Lesions Using Autologous Pericardium vs Porcine Intestinal Submucosa

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.

Bicuspid aortic valve repair: An ongoing struggle in material science

BACKGROUND

Techniques and results of aortic valve repair remain challenging.

AIMS

Safari et al. seek to improve aortic valve repair by either aortic patching or valve sparing root replacement.

MATERIALS AND METHODS

The results of bicuspid aortic valve (BAV) repair in 142 patients were examined withor without valve sparing root replacement.

RESULTS

Isolated BAV repair with or without valve sparing root replacement provided goodclinical outcomes with relatively low reoperation rate and durable valve function.

DISCUSSION

While clinical outcome from BAV repair was generally good, the authors have stopped pericardial patch augmentation of BAV leaflets due to suboptimal durability.

CONCLUSION

Thelack of a durable valve patch material and the modest durability of BAV repairin general point out that aortic valve repair remains an ongoing struggle inmaterial science.