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Ann Thorac Surg 2006;82:1292-1300
© 2006 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Short and Midterm Results of Aortic Valve Cusp Extension in the Treatment of Children With Congenital Aortic Valve Disease

^a Division of Cardiovascular Surgery, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
^b Division of Cardiology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
^c Department of Cardiology, Stollery Children's Hospital, Alberta, Canada
^d King Faisal Heart Institute at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Accepted for publication April 7, 2006.

^_* Address correspondence to Dr Alsoufi, King Faisal Heart Institute (MBC 16), King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211, Saudi Arabia (Email: balsoufi{at}hotmail.com).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

BACKGROUND: We evaluated our experience with aortic valve cusp extension techniques to identify predictors of successful intraoperative repair and subsequent durability.

METHODS: Twenty-two children (ages 5–18 years) underwent aortic cusp extension with autologous pericardium between 1999 and 2005. Sixteen children had previous surgical or percutaneous intervention. Ten children had bicuspid aortic valves. Cusp extensions were performed on 1 cusp in 3 patients, 2 cusps in 3, and 3 cusps in 16. Serial echocardiographic measures (n = 81) were obtained during a 5-year period and underwent blinded review. Longitudinal trajectories of ventricular and aortic valve function were modeled using mixed linear regression analysis.

RESULTS: There was no hospital or late mortality. Five-year freedom from valve replacement was 75%. Comparison of preoperative and post-repair echocardiograms demonstrated reductions in aortic insufficiency (decreased in jet-width/aortic valve diameter ratio from 0.39 ± 0.12 to 0.22 ± 0.11; p < 0.0001), aortic stenosis (decreased in peak aortic valve gradient from 41 ± 25 mm Hg to 29 ± 15 mm Hg; p = 0.04), and left ventricular end-diastolic dimensions Z-score (decreased from 1.39 ± 0.38 to 1.16 ± 0.34; p < 0.001). During the follow-up period, post-repair jet-width and aortic valve diameter increased nonlinearly (p < 0.001). Patients with postoperative peak aortic gradients greater than 30 mm Hg had progression of aortic stenosis, whereas those with lesser postoperative peak gradients tended to regress during follow-up (p < 0.001). The decrement in Z-score of the left ventricular end-diastolic dimensions remained stable during the follow-up period.

CONCLUSIONS: Aortic valve cusp extension can result in acceptable hemodynamic results with stabilization of left ventricular geometry. However, residual lesions are common and progression and regression of these lesions can be predicted based on echocardiographic data.

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