Abstract
We sought to characterize the incidence of AR progression and determine risk factors for AR progression in a consecutive series of infants and children after surgical correction of congenital aortic valvular and supravalvular stenosis. N = 30 patients underwent repair of the aortic valve for isolated congenital aortic valve stenosis (n = 14, 47 %) or combined with aortic regurgitation (AR, n = 16, 53 %). N = 27 (90 %) had a valvular and n = 3 patients (10 %) presented with supravalvular pathology of their aortic valve. In n = 16 patients (53 %) a bicuspid and in n = 2 (6 %) patients, a unicuspid valve was present. Comparative survival was analyzed using the Cox model and log-rank calculations. Log-rank calculations were performed for variables reaching statistical significance in order to identify differences in survival between groups. Commissurotomy was performed in n = 20 patients, patch implantation in n = 4, cusp shaving in n = 8, cusp prolapse correction in n = 3, and cusp augmentation in n = 4 patients. In patients with combined dysfunction and preoperative AR, AR was successfully reduced by the initial procedure, and postoperatively the overall median AR grade was 1+ (range 0–2.5+, p = 0.001, for AR reduction among patients with any grade of preoperative AR). By the time of follow-up echocardiography, the median AR grade had significantly progressed toward 1.5+ (p = 0.004). At the time of mid-term follow-up at 3.2 years, none of the patients had moderate or severe AR grades >2.5+. Patients with a monocuspid aortic valve and patients who had some kind of patch implantation into their cusps or commissures or shaving of thickened cusps were more likely to present with progression of aortic regurgitation. Monocuspid aortic valve and patch implantation, as well as cusp shaving, are probably linked to AR progression. The standard procedure of commissurotomy results in an absolute rate of AR progression of 40 % over a medium-term follow-up period.
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References
Aicher D, Fries R, Rodionycheva S, Schmidt K, Langer F, Schaefers HJ (2010) Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac Surg 37:127–132
Alsoufi B, Borger MA, Armstrong S, Maganti M, David TE (2005). Results of valve preservation and repair for bicuspid aortic valve insufficiency. J Heart Valve Dis 14:752–758, discussion 758–759
Bakhtiary F, Amer M, Etz CD, Dahnert I, Wilhelm Mohr F, Bellinghausen W, Kostelka M (2013) Mid-term outcome after surgical repair of congenital supravalvular aortic stenosis by extended aortoplasty. Interact CardioVasc Thorac Surg 17:688–690
Boodhwani M, El Khoury G (2010). Principles of aortic valve repair. J Thorac Cardiovasc Surg 140:S20–S22, discussion S45–S51
Brown JW, Rodefeld MD, Ruzmetov M, Eltayeb O, Yurdakok O, Turrentine MW (2012) Surgical valvuloplasty versus balloon aortic dilation for congenital aortic stenosis: are evidence-based outcomes relevant? Ann Thorac Surg 94:146–153, discussion 153–145
Deo SV, Burkhart HM, Schaff HV, Li Z, Stensrud PE, Olson TM, Connolly HM, Dearani JA (2013) Late outcomes for surgical repair of supravalvar aortic stenosis. Ann Thorac Surg 94:854–859
d’Udekem Y, Sharma V (2013) Repair options in rheumatic aortic valve disease in young patients: potential problems with pericardial cusp extension. World J Pediatr Congenit Heart Surg 4:392–396
d’Udekem Y, Siddiqui J, Seaman CS, Konstantinov IE, Galati JC, Cheung MM, Brizard CP (2013) Long-term results of a strategy of aortic valve repair in the pediatric population. J Thorac Cardiovasc Surg 145:461–467, discussion 467–469
El Khoury G, de Kerchove L (2013) Principles of aortic valve repair. J Thorac Cardiovasc Surg 145:S26–S29
Kalangos A, Myers PO (2013) Aortic cusp extension for surgical correction of rheumatic aortic valve insufficiency in children. World J Pediatr Congenit Heart Surg 4:385–391
Kari FA, Siepe M, Sievers HH, Beyersdorf F (2013) Repair of the regurgitant bicuspid or tricuspid aortic valve: background, principles, and outcomes. Circulation 128:854–863
Kari FA, Liang DH, Escobar Kvitting JP, Stephens EH, Mitchell RS, Fischbein MP, Miller DC (2013) Tirone David valve-sparing aortic root replacement and cusp repair for bicuspid aortic valve disease. J Thorac Cardiovasc Surg 145:S35–S40
Kramer P, Absi D, Hetzer R, Photiadis J, Berger F, Alexi-Meskishvili V (2013) Outcome of surgical correction of congenital supravalvular aortic stenosis with two- and three-sinus reconstruction techniques. Ann Thorac Surg 97:634–640
Kvitting JP, Kari FA, Fischbein MP, Liang DH, Beraud AS, Stephens EH, Mitchell RS, Miller DC (2012). David valve-sparing aortic root replacement: equivalent mid-term outcome for different valve types with or without connective tissue disorder. J Thorac Cardiovasc Surg 145:117–126, 127 e111–e115, discussion 126–117
Luciani GB, De Rita F, Lucchese G, Hila D, Rungatscher A, Faggian G, Mazzucco A (2013) Repair of congenitally dysplastic aortic valve by bicuspidization: midterm results. Ann Thorac Surg 94:1173–1179
Siddiqui J, Brizard CP, Galati JC, Iyengar AJ, Hutchinson D, Konstantinov IE, Wheaton GR, Ramsay JM, d’Udekem Y (2013) Surgical valvotomy and repair for neonatal and infant congenital aortic stenosis achieves better results than interventional catheterization. J Am Coll Cardiol 62:2134–2140
Stephens EH, Liang DH, Kvitting JP, Kari FA, Fischbein MP, Mitchell RS, Miller DC (2013) Incidence and progression of mild aortic regurgitation after Tirone David reimplantation valve-sparing aortic root replacement. J Thorac Cardiovasc Surg 147:169–178
Svensson LG, Batizy LH, Blackstone EH, Gillinov AM, Moon MC, D’Agostino RS, Nadolny EM, Stewart WJ, Griffin BP, Hammer DF, Grimm R, Lytle BW (2011) Results of matching valve and root repair to aortic valve and root pathology. J Thorac Cardiovasc Surg 142(1491–1498):e1497
Author Contributions
Kari was the primary author and performed data analysis, data acquisition, and study design and was involved in clinical treatment. Kroll was the primary surgeon and was involved in operations, paper revision, and study design. Kiss contributed to paper revision and data acquisition. Hess collected the data. Stiller performed clinical treatment, paper revision, and study design. Beyersdorf helped in clinical treatment, paper revision, and study design. Siepe contributed to clinical treatment, paper revision, and study design.
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Kari, F.A., Kroll, J., Kiss, J. et al. Progression of Aortic Regurgitation After Different Repair Techniques for Congenital Aortic Valve Stenosis. Pediatr Cardiol 37, 84–89 (2016). https://doi.org/10.1007/s00246-015-1243-0
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DOI: https://doi.org/10.1007/s00246-015-1243-0