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The utility of aortic valve leaflet reconstruction techniques in children and young adults
- Source :
- The Journal of Thoracic and Cardiovascular Surgery. 159:2369-2378
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- The treatment of aortic valve disease in children and adolescents requires an individualized approach to provide a long-term solution with optimal hemodynamic profile. The role of aortic leaflet reconstruction techniques is evolving.We retrospectively reviewed the charts of 58 patients who underwent aortic valve tricuspidalization either by an Ozaki procedure (neo-tricuspidalization) or single leaflet reconstruction between 2015 and 2019. Immediate operative results as well as hospital and short-term outpatient follow-up data were evaluated.Fifty-eight patients underwent leaflet reconstruction with 40 (69%) receiving a neo-tricuspidalization and 18 patients (31%) undergoing single leaflet reconstruction, using either a glutaraldehyde fixed autologous pericardium or tissue engineered bovine pericardium (CardioCel; Admedus, Queensland, Australia). The median age at the time of surgery was 14.8 years (interquartile range, 10.6-16.8 years). Twenty-three patients (40%) had isolated aortic regurgitation. The peak velocity across the aortic valve decreased from 3.4 ± 1.2 meters per second (m/s) preoperatively to 2.0 ± 0.4 m/s (P .001) after surgery and remained stable (2.2 ± 0.7 m/s) during a median echocardiographic follow-up of 14.1 months (7.2-20.1 months) for the whole cohort. Freedom from reoperation or moderate and greater aortic regurgitation at 1, 2, and 3 years was 94.2% ± 3.3%, 85.0% ± 5.8%, and 79.0% ± 8.0%, respectively, with no difference between the neo-tricuspidalization and single leaflet reconstruction groups (P = .635). There were 6 late reoperations (10%) of which 3 were due to endocarditis.Aortic leaflet reconstruction provides acceptable short-term hemodynamic outcomes and proves the utility of this technique as an adjunctive strategy for surgical treatment of aortic valve disease in children and young adults.
- Subjects :
- Male
Reoperation
Pulmonary and Respiratory Medicine
Aortic valve
medicine.medical_specialty
Time Factors
Adolescent
Bovine pericardium
Aortic Valve Insufficiency
Transplantation, Heterologous
Heart Valve Diseases
Hemodynamics
Regurgitation (circulation)
030204 cardiovascular system & hematology
Transplantation, Autologous
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Bicuspid Aortic Valve Disease
Risk Factors
Interquartile range
medicine
Animals
Humans
cardiovascular diseases
Cardiac Surgical Procedures
Young adult
Child
Retrospective Studies
Tissue engineered
Leaflet (botany)
business.industry
Age Factors
Aortic Valve Stenosis
Recovery of Function
Plastic Surgery Procedures
Surgery
Treatment Outcome
medicine.anatomical_structure
030228 respiratory system
Aortic Valve
cardiovascular system
Cattle
Female
Cardiology and Cardiovascular Medicine
business
Pericardium
Subjects
Details
- ISSN :
- 00225223
- Volume :
- 159
- Database :
- OpenAIRE
- Journal :
- The Journal of Thoracic and Cardiovascular Surgery
- Accession number :
- edsair.doi.dedup.....8af107908e6ce91c6c60ff7312fac98f