Aortic Cusp Extension for Surgical Correction of Rheumatic Aortic Valve Insufficiency in Children

被引:10
|
作者
Kalangos, Afksendiyos [1 ]
Myers, Patrick O. [1 ]
机构
[1] Geneva Univ Hosp & Fac Med, Div Cardiovasc Surg, 4 Rue Gabrielle Perret Gentil, CH-1211 Geneva, Switzerland
关键词
aortic valve repair; congenital heart surgery; heart valve; rheumatic;
D O I
10.1177/2150135113498785
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Surgical management of aortic insufficiency in the young is problematic because of the lack of an ideal valve substitute. Potential advantages of aortic valve repair include low incidences of thromboembolism and endocarditis, avoiding conduit replacements, the maintenance of growth potential, and improved quality of life. Aortic valve repair is still far from fulfilling the three key factors that have allowed the phenomenal development of mitral valve repair (standardization, reproducibility, and stable long-term results); however, techniques of aortic valve repair have been refined, and subsets of patients amenable to repair have been identified. We have focused on the oldest technique of aortic valve repair, cusp extension, focusing on children with rheumatic aortic insufficiency. Among 77 children operated from 2003 to 2007, there was one early death from ventricular failure and one late death from sudden cardiac arrhythmia. During a mean follow-up of 12.8 +/- 5.9 years, there were 16 (20.5%) reoperations on the aortic valve, at a median of 3.4 years (range, 2 months to 18.3 years) from repair. Freedom from aortic valve reoperation was 96.2% +/- 2.2% at 1 year, 94.9% +/- 2.5% at 2 years, 88.5% +/- 3.6% at 5 years, 81.7% +/- 4.4% at 10 years, 79.7% +/- 4.8% at 15 years, and 76.2% +/- 5.7% at 20 years. Although aortic cusp extension is technically more demanding, it remains particularly more suitable in the context of evolving rheumatic aortic insufficiency in children with a small aortic annulus as a bridge surgical approach to late aortic valve replacement with a larger valvular prosthesis.
引用
收藏
页码:385 / 391
页数:7
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