Long-term outcomes of aortic valve repair in children with congenital heart disease and their predictors
https://doi.org/10.15829/1560-4071-2020-3971
Abstract
Aim. To retrospectively analyze the long-term results of primary aortic valve repair (AVR) in children.
Material and methods. The study included 163 patients operated on from 2004 to 2019. The mean age was 9,58±9,3 years. The patients underwent commissurotomy, decalcification, raphe resection, Trusler technique, raphe shaving, free margin plication, leaflet replacement, leaflet extension, subcommissural annuloplasty, valve sparing aortic root replacement and neocuspidization. Primary endpoint was a composite outcome of freedom from reoperation, recurrent greater than moderate aortic regurgitation, stenosis, whereas secondary — overall survival.
Results. The indications for the procedure were stenotic, regurgitant or mixed defect in 80 (49,1%), 38 (23,3%), and 45 (27,6%) patients, respectively. The 10-year survival rate was 99,4%. The mean follow-up was 3,6±1,8 years. Freedom from reoperation, recurrent moderate and greater aortic regurgitation, stenosis at 1,5 and 7 years was, 95%, 70% and 47%, respectively. In multivariate analysis, Trusler technique, leaflet extension, raphe shaving, use of patch, leaflet retraction, complexity of repair were predictors for composite outcome.
Conclusion. Reconstruction of aortic valve in children is effective and safe. Avoidance of predictors may significantly improve the long-term results of aortic valve repair.
About the Authors
Z. M. Abdurakhmanov
Ukrainian Children’s Cardiac Center; Bukhara State Medical Institute
Uzbekistan
Bukhara
Kyiv
Uzbekistan
Bukhara
Kyiv
I. N. Yemets
Ukrainian Children’s Cardiac Center
Ukraine
Kyiv
Ukraine
Kyiv
References
1. Moons P, Sluysmans T, De Wolf D, et al. Congenital heart disease in 111 225 births in Belgium: birth prevalence, treatment and survival in the 21st century. Acta Paediatr. 2009;98:472-9. doi:10.1111/j.1651-2227.2008.01152.x.
2. Alsoufi B, Al-Halees Z, Manlhiot C, et al. Mechanical valves versus the Ross procedure for aortic valve replacement in children: propensity-adjusted comparison of long-term outcomes. J Thorac Cardiovasc Surg. 2009;137:362-70. doi:10.1016/j.jtcvs.2008.10.010.
3. Nelson JS, Pasquali SK, Pratt CN, et al. Long-term survival and reintervention after the Ross procedure across the pediatric age spectrum. Ann Thorac Surg. 2015;99:2086-94. doi:10.1016/j.athoracsur.2015.02.068.
4. Alsoufi B, d‘Udekem Y. Aortic valve repair and replacement in children. Future Cardiology. 2014;10(1):105-115. doi:10.2217/fca.13.88.
5. Vergnat M, Asfour B, Arenz C, et al. Contemporary results of aortic valve repair for congenital disease: lessons for management and staged strategy. Eur J Cardiothorac Surg. 2017;52(3):581-7. doi:10.1093/ejcts/ezx172.
6. Gasparyan VC. Method of determination of aortic valve parameters for its reconstruction with autopericardim: an experimental study. J Thorac Cardiovasc Surg. 2000;119(2):386-7. doi:10.1016/S0022-5223(00)70200-5.
7. Ozaki S, Kawase I, Yamashita H, et al. A total of 404 cases of aortic valve reconstruction with glutaraldehyde-treated autologous pericardium. J Thorac Cardiovasc Surg. 2014;147:301-6. doi:10.1016/j.jtcvs.2012.11.012.
8. Juthier F, Banfi C, Vincentelli A, et al. Modified Ross operation with reinforcement of the pulmonary autograft: six-year results. J Thorac Cardiovasc Surg. 2010;139:1420-3. doi:10.1016/j.jtcvs.2010.01.032.
9. Bansal N, Kumar SR, Baker CJ, et al. Age-related outcomes of the Ross procedure over 20 years. Ann Thorac Surg. 2015;99:2077-83. doi:10.1016/j.athoracsur.2015.02.066.
10. Poncelet AJ, El Khoury G, de Kerchove L, et al. Aortic valve repair in the paediatric population: insights from a 38-year single-centre experience. Eur. J. Cardiothorac. Surg. 2017;51(1):43-9. doi:10.1093/ejcts/ezw259.
11. Bacha EA, McElhinney DB, Guleserian KJ, et al. Surgical aortic valvuloplasty in children and adolescents with aortic regurgitation: acute and intermediate effects on aortic valve function and left ventricular dimensions. J Thorac Cardiovasc Surg. 2008;135:552-9. doi:10.1016/j.jtcvs.2007.09.057.
12. Khan MS, Samayoa AX, Chen DW, et al. Contemporary experience with surgical treatment of aortic valve disease in children. J Thorac Cardiovasc Surg. 2013;146(3):512-20. doi:10.1016/j.jtcvs.2013.04.014.
13. d’Udekem Y, Siddiqui J, Seamen CS, et al. Long-term results of a strategy of aortic valve repair in the pediatric population. J Thorac Cardiovasc Surg. 2013;145(2):461-7. doi:10.1016/j.jtcvs.2012.11.033.
14. Wilder TJ, Caldarone CA, Van Arsdell GS, et al. Aortic valve repair for insufficiency in older children offers unpredictable durability that may not be advantageous over a primary Ross operation. Eur J Cardiothorac Surg. 2016;49(23):883-92. doi:10.1093/ejcts/ezv185.
15. Baird CW, Marathe SP, del Nido PJ. Aortic valve neo-cuspidation using the Ozaki technique for acquired and congenital disease: where does this procedure currently stand? Ind J of Thorac and Cardiovasc Surg. 2020;36:113-22. doi:10.1007/s12055019-00917-9.
16. Akiyama S, Iida Y, Shimura K, et al. Midterm outcome of aortic valve neocuspidization for aortic valve stenosis with small annulus. Gen Thorac Cardiovasc Surg. 2020. doi:10.1007/s11748-020-01299-1.
Review
For citations:
Abdurakhmanov Z.M., Yemets I.N. Long-term outcomes of aortic valve repair in children with congenital heart disease and their predictors. Russian Journal of Cardiology. 2020;25(8):3971. (In Russ.) https://doi.org/10.15829/1560-4071-2020-3971
Views:
747
Email this article 