Age-adjusted long-term outcomes of aortic valve repair in children

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OBJECTIVE

To analyze the age-adjusted long-term results of aortic valve (AV) repair in children of different age groups (<10 years and >10 years) excluding neonates, secondary AV repair and conotruncal heart defects.

MATERIAL AND METHODS

Effectiveness of AV repair was studied in 106 (65.1%) children aged <10 years (group 1) and 57 (34.9%) children aged >10 years (group 2). In group 1, indications for surgery were aortic insufficiency (AI), aortic stenosis (AS) and combined disease in 70 (66.0%), 12 (11.3%) and 24 (22.7%) patients, respectively. In the 2^nd group, these lesions were observed in 26 (45.6%), 10 (17.6%) and 21 (36.8%) patients, respectively. AV repair was performed for isolated AI and predominant AI in patients with combined AV lesion. Commissurotomy and leaflet decalcification were used for isolated aortic stenosis. The Ozaki procedure was performed in patients with combined lesion of unicuspid AV or enlarged aortic annulus. Combined primary end-point was freedom from redo surgery and AS/AI >2.

RESULTS

Peak (p<0.001) and mean pressure gradient (p<0.001), as well as AI (in patients <10 years p<0.001, in patients >10 years p=0.014) decreased in all cases. Free edge plication, subcommissural annuloplasty and commissurotomy with decalcification are effective in children <10 years. Other two methods (raphe shaving and Trusler technique) are equally less effective, while cusp augmentation and replacement are followed by poor long-term results. In children >10 years, all techniques excluding cusp augmentation and Trusler technique demonstrate ≥70% freedom from combined endpoint in long-term follow-up period. The Ozaki procedure was effective throughout 2-year follow-up in all cases.

CONCLUSION

Aortic valve repair is effective in different age groups for postponing valve replacement. This approach provides further growth of aortic root. Age-oriented surgical strategy may contribute to better long-term outcomes of AV repair.

Keywords:

aortic valve repair

aortic stenosis

aortic regurgitation

Authors:

Abdurakhmanov Z.M.

Bukhara State Medical Institute

ORCID: 0000-0002-0444-9791

Yemets I.M.

Ukrainian Children’s Cardiac Center

ORCID: 0000-0002-1893-0164

Received:

02.04.2022

Accepted:

15.07.2022

List of references:

Abdurakhmanov ZM, Abdurakhmanov MM, Yemets IN. Children with congenital disease amenable to aortic valve repairs: lessons for management and where do these techniques currently stand? J Angiol Vasc Surg. 2020;5:046. https://doi.org/10.24966/AVS-7397/100046
Boodhwani M, de Kerchove L, Glineur D, Poncelet A, Rubay J, Astarci P, Verhelst R, Noirhomme P, El Khoury G. Repair-oriented classiﬁcation of aortic insufﬁciency: impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg. 2009;137:286-294. https://doi.org/10.1016/j.jtcvs.2008.08.054
Aicher D, Fries R, Rodionycheva S, Schmidt K, Langer F, Schäfers HJ. Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac Surg. 2010;37:127-132. https://doi.org/10.1016/j.ejcts.2009.06.021
Nelson JS, Pasquali SK, Pratt CN, Yu S, Donohue JE, Loccoh E, Ohye RG, Bove EL, Hirsch-Romano JC. Long-term survival and reintervention after the Ross procedure across the pediatric age spectrum. Ann Thorac Surg. 2015;99:2086-2094. https://doi.org/10.1016/j.athoracsur.2015.02.068
Lo Rito M, Davies B, Brawn WJ, Jones TJ, Khan N, Stickley J, Barron DJ. Comparison of the Ross/Ross-Konno aortic root in children before and after the age of 18months. Eur J Cardiothorac Surg. 2014;46:450-457. https://doi.org/10.1093/ejcts/ezt631
Clark JB, Pauliks LB, Rogerson A, Kunselman AR, Myers JL. The Ross operation in children and young adults: a fifteen-year, single-institution experience. Ann Thorac Surg. 2011;91:1936-1942. https://doi.org/10.1016/j.athoracsur.2010.12.070
Alsoufi B, Manlhiot C, Fadel B, Al-Ahmadi M, Tamim M, McCrindle BW, Canver CC, Al-Halees Z. The Ross procedure in children: preoperative haemodynamic manifestation has significant effect on late autograft re-operation. Eur J Cardiothorac Surg. 2010;38:547-555. https://doi.org/10.1016/j.ejcts.2010.03.025
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(2):461-467. https://doi.org/10.1016/j.jtcvs.2012.11.033
Wilder TJ, Caldarone CA, Van Arsdell GS, Pham-Hung E, Gritti M, Al Jughiman M, Hickey EJ. 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):883-892. https://doi.org/10.1093/ejcts/ezv185
Miyamoto T, Sinzobahamvya N, Wetter J, Kallenberg R, Brecher AM, Asfour B, Urban AE. Twenty years experience of surgical aortic valvotomy for critical aortic stenosis in early infancy. Eur J Cardiothorac Surg. 2006;30:35-40. https://doi.org/10.1016/j.ejcts.2006.03.050
Alsoufi B, d’Udekem Y. Aortic valve repair and replacement in children. Future Cardiology. 2014;10(1):105-115. https://doi.org/10.2217/fca.13.88
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(3):581-587. https://doi.org/10.1093/ejcts/ezx172
El Khoury G, Glineur D, Rubay J, Verhelst R, d’Acoz Yd, Poncelet A, Astarci P, Noirhomme P, van Dyck M. Functional classification of aortic root/valve abnormalities and their correlation with etiologies and surgical procedures. Curr Opin in Card. 2005;20(2):115-121. https://doi.org/10.1097/01.hco.0000153951.31887.a6
Trusler GA, Iyengar SR, Mustard WT. Reconstruction of the pulmonary valve and outflow tract. A report of 25 cases. J Thorac Cardiovasc Surg. 1973;65:245-251.
Cabrol C, Cabrol A, Guiraudon G, Bertrand M. Treatment of aortic insufficiency by means of aortic annuloplasty. Arch Mal Coeur Vaiss. 1966;59:1305-1312.
Abeln KB, Chauvette V, Poirier N, Matsushima S, El-Hamamsy I, Schäfers HJ. Ross operation after failure of aortic valve repair. Ann Cardiothorac Surg. 2021;10(4):476-484. https://doi.org/10.21037/acs-2020-rp-19
Sharabiani MT, Dorobantu DM, Mahani AS, Turner M, Peter Tometzki AJ, Angelini GD, Parry AJ, Caputo M, Stoica SC. Aortic valve replacement and the Ross operation in children and young adults. J Am Coll Cardiol. 2016;6724:2858-2870. https://doi.org/10.1016/j.jacc.2016.04.021
Juthier F, Banfi C, Vincentelli A, Ennezat PV, Le Tourneau T, Pinçon C, Prat A. Modified Ross operation with reinforcement of the pulmonary autograft: six-year results. J Thorac Cardiovasc Surg. 2010;139:1420-1423. https://doi.org/10.1016/j.jtcvs.2010.01.032
Zacek P, Holubec T, Vobornik M, Dominik J, Takkenberg J, Harrer J, Vojacek J. Quality of life after aortic valve repair is similar to Ross patients and superior to mechanical valve replacement: a cross-sectional study. BMC Cardiovasc Disord. 2016;16:63. https://doi.org/10.1186/s12872-016-0236-0
Agnoletti G, Raisky O, Boudjemline Y, Ou P, Bonnet D, Sidi D, Vouhé P. Neonatal surgical aortic commissurotomy: predictors of outcome and long-term results. Ann Thorac Surg. 2006;82:1585-1592. https://doi.org/10.1016/j.athoracsur.2006.05.049
Vergnat M, Roubertie F, Lambert V, Laux D, Ly M, Roussin R, Baruteau AE, Capderou A, Kalfa D, Belli E. Mitral disease: the real burden for Ross-Konno procedure in children. Ann Thorac Surg. 2014;98:2165-2171. https://doi.org/10.1016/j.athoracsur.2014.06.063
Karamlou T, Shen I, Alsoufia B, Burch G, Reller M, Silberbach M, Ungerleider RM. The influence of valve physiology on outcome following aortic valvotomy for congenital bicuspid valve in children: 30-year results from a single institution. Eur J Cardiothorac Surg. 2005;27:81-85. https://doi.org/10.1016/j.ejcts.2004.10.044
Karl TR. Left ventricular outflow tract obstruction: justification for a more definitive repair in the neonate? Eur J Cardiothorac Surg. 2012;42:694-695. https://doi.org/10.1093/ejcts/ezs052
Prijic SM, Vukomanovic VA, Stajevic MS, Bjelakovic BB, Zdravkovic MD, Sehic IN, Kosutic JLj. Balloon dilation and surgical valvotomy comparison in non-critical congenital aortc valve stenosis. Pediatr Cardiol. 2015;36:616-624.
Hill GD, Ginde S, Rios R, Frommelt PC, Hill KD. Surgical valvotomy versus balloon valvuloplasty for congenital aortic valve stenosis: a systematic review and meta-analysis. J Am Heart Assoc. 2016;5. https://doi.org/10.1161/JAHA.116.003931
de Kerchove L, Boodhwani M, Glineur D, Vandyck M, Vanoverschelde JL, Noirhomme P, El Khoury G. Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair. J Thorac Cardiovasc Surg. 2013;146(3):512-520. https://doi.org/10.1016/j.jtcvs.2011.08.021
Christopher WB, Supreet P, Marathe1, 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;36:113-122. https://doi.org/10.1007/s12055-019-00917-9
Abdurakhmanov ZM, Yemets IN. 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
Abdurakhmanov ZM, Yemets IN. Early and long-term results of reconstructive surgery for congenital aortic valve diseases in pediatric population. Bulletin of Pirogov National Medical & Surgical Center. 2020;2(15):38-43. (In Russ.). https://doi.org/10.25881/BPNMSC.2020.57.92.005
Akiyama S, Iida Y, Shimura K, Fujii S, Shimizu H, Sawa S. Midterm outcome of aortic valve neocuspidization for aortic valve stenosis with small annulus. Gen Thorac Cardiovasc Surg. 2020;68(8):762-767. https://doi.org/10.1007/s11748-020-01299-1
Norio T, Naoyuki T, Kazuo A, Masaki H. Transcatheter aortic valve implantation after aortic valve neocuspidization using autologous pericardium: a case report. Eur Heart J Case Rep. 2019;3(3):105. https://doi.org/10.1093/ehjcr/ytz105

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