Aortic cusp extension valvuloplasty with or without tricuspidization in children and adolescents: Long-term results and freedom from aortic valve replacement

Anastasios Charalanpos Polimenakos, Shyam Sathanandam, Chawki ElZein, Mary J. Barth, Robert S D Higgins, Michel N. Ilbawi

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objective: Aortic cusp extension valvuloplasty is increasingly used in the management of children and adolescents with aortic stenosis or regurgitation. The durability of this approach and the freedom from valve replacement are not well defined. A study was undertaken to investigate outcomes. Methods: From July 1987 to November 2008, 142 patients aged less than 19 years underwent aortic cusp extension valvuloplasty in the form of pericardial cusp extension and tricuspidization (when needed). Three patients with truncus arteriosus and severe truncal valve insufficiency were excluded. From the available follow-up data of 139 patients, 50 had bicuspid aortic valves, 40 had congenital aortic valve stenosis, 41 had combined congenital aortic valve stenosis/insufficiency, and 8 had other diagnoses. Median follow-up was 14.4 years (0.1-21.4). Long-term mortality and freedom from aortic valve replacement were studied. Results: There were no early, intermediate, or late deaths. Z-values of left ventricular end-diastolic dimension, aortic annulus, aortic sinus diameter, and sinotubular junction diameter before aortic valve replacement were 4.2 ± 3.11, 2.3 ± 1.25, 4.4 ± 1.23, and 1.84 ± 1.28, respectively. During the follow-up period, 64 patients underwent aortic valve reinterventions. The Ross procedure was performed in 32 of 139 patients (23%) undergoing aortic cusp extension valvuloplasty. Other aortic valve replacements were undertaken after 16 aortic cusp extension valvuloplasties (11.5%). Freedom from a second aortic cusp extension valvuloplasty or aortic valve replacement at 18 years was 82.1% ± 4.2% and 60.0% ± 7.2%, respectively. Conclusion: Aortic cusp extension valvuloplasty is a safe and effective surgical option with excellent survival and good long-term outcomes in children and adolescents. The procedure provides acceptable durability and satisfactory freedom from aortic valve replacement.

Original languageEnglish (US)
Pages (from-to)933-941
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume139
Issue number4
DOIs
StatePublished - Apr 1 2010
Externally publishedYes

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Aortic Valve
Aortic Valve Stenosis
Aortic Valve Insufficiency
Truncus Arteriosus
Sinus of Valsalva
Survival
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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Aortic cusp extension valvuloplasty with or without tricuspidization in children and adolescents : Long-term results and freedom from aortic valve replacement. / Polimenakos, Anastasios Charalanpos; Sathanandam, Shyam; ElZein, Chawki; Barth, Mary J.; Higgins, Robert S D; Ilbawi, Michel N.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 139, No. 4, 01.04.2010, p. 933-941.

Research output: Contribution to journalArticle

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title = "Aortic cusp extension valvuloplasty with or without tricuspidization in children and adolescents: Long-term results and freedom from aortic valve replacement",
abstract = "Objective: Aortic cusp extension valvuloplasty is increasingly used in the management of children and adolescents with aortic stenosis or regurgitation. The durability of this approach and the freedom from valve replacement are not well defined. A study was undertaken to investigate outcomes. Methods: From July 1987 to November 2008, 142 patients aged less than 19 years underwent aortic cusp extension valvuloplasty in the form of pericardial cusp extension and tricuspidization (when needed). Three patients with truncus arteriosus and severe truncal valve insufficiency were excluded. From the available follow-up data of 139 patients, 50 had bicuspid aortic valves, 40 had congenital aortic valve stenosis, 41 had combined congenital aortic valve stenosis/insufficiency, and 8 had other diagnoses. Median follow-up was 14.4 years (0.1-21.4). Long-term mortality and freedom from aortic valve replacement were studied. Results: There were no early, intermediate, or late deaths. Z-values of left ventricular end-diastolic dimension, aortic annulus, aortic sinus diameter, and sinotubular junction diameter before aortic valve replacement were 4.2 ± 3.11, 2.3 ± 1.25, 4.4 ± 1.23, and 1.84 ± 1.28, respectively. During the follow-up period, 64 patients underwent aortic valve reinterventions. The Ross procedure was performed in 32 of 139 patients (23{\%}) undergoing aortic cusp extension valvuloplasty. Other aortic valve replacements were undertaken after 16 aortic cusp extension valvuloplasties (11.5{\%}). Freedom from a second aortic cusp extension valvuloplasty or aortic valve replacement at 18 years was 82.1{\%} ± 4.2{\%} and 60.0{\%} ± 7.2{\%}, respectively. Conclusion: Aortic cusp extension valvuloplasty is a safe and effective surgical option with excellent survival and good long-term outcomes in children and adolescents. The procedure provides acceptable durability and satisfactory freedom from aortic valve replacement.",
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T2 - Long-term results and freedom from aortic valve replacement

AU - Polimenakos, Anastasios Charalanpos

AU - Sathanandam, Shyam

AU - ElZein, Chawki

AU - Barth, Mary J.

AU - Higgins, Robert S D

AU - Ilbawi, Michel N.

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AB - Objective: Aortic cusp extension valvuloplasty is increasingly used in the management of children and adolescents with aortic stenosis or regurgitation. The durability of this approach and the freedom from valve replacement are not well defined. A study was undertaken to investigate outcomes. Methods: From July 1987 to November 2008, 142 patients aged less than 19 years underwent aortic cusp extension valvuloplasty in the form of pericardial cusp extension and tricuspidization (when needed). Three patients with truncus arteriosus and severe truncal valve insufficiency were excluded. From the available follow-up data of 139 patients, 50 had bicuspid aortic valves, 40 had congenital aortic valve stenosis, 41 had combined congenital aortic valve stenosis/insufficiency, and 8 had other diagnoses. Median follow-up was 14.4 years (0.1-21.4). Long-term mortality and freedom from aortic valve replacement were studied. Results: There were no early, intermediate, or late deaths. Z-values of left ventricular end-diastolic dimension, aortic annulus, aortic sinus diameter, and sinotubular junction diameter before aortic valve replacement were 4.2 ± 3.11, 2.3 ± 1.25, 4.4 ± 1.23, and 1.84 ± 1.28, respectively. During the follow-up period, 64 patients underwent aortic valve reinterventions. The Ross procedure was performed in 32 of 139 patients (23%) undergoing aortic cusp extension valvuloplasty. Other aortic valve replacements were undertaken after 16 aortic cusp extension valvuloplasties (11.5%). Freedom from a second aortic cusp extension valvuloplasty or aortic valve replacement at 18 years was 82.1% ± 4.2% and 60.0% ± 7.2%, respectively. Conclusion: Aortic cusp extension valvuloplasty is a safe and effective surgical option with excellent survival and good long-term outcomes in children and adolescents. The procedure provides acceptable durability and satisfactory freedom from aortic valve replacement.

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