Contemporary results of aortic valve repair for congenital disease: lessons for management and staged strategy
Any aortic valve (AoV) operation in children (repair, Ross or mechanical replacement) is a palliation and reinterventions are frequent. AoV repair is a temporary solution primarily aimed at allowing the patient to grow to an age when more definitive solutions are available. We retrospectively analys...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 2017-09, Vol.52 (3), p.581-587 |
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| creator | Vergnat, Mathieu Asfour, Boulos Arenz, Claudia Suchowerskyj, Philipp Bierbach, Benjamin Schindler, Ehrenfried Schneider, Martin Hraska, Victor |
| description | Any aortic valve (AoV) operation in children (repair, Ross or mechanical replacement) is a palliation and reinterventions are frequent. AoV repair is a temporary solution primarily aimed at allowing the patient to grow to an age when more definitive solutions are available. We retrospectively analysed AoV repair effectiveness across the whole age spectrum of children, excluding neonates and AoV disease secondary to congenital heart disease.
From 2003 to 2015, 193 consecutive patients were included. The mean age was 9.2 ± 6.9 years (22% |
| doi_str_mv | 10.1093/ejcts/ezx172 |
| format | Article |
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From 2003 to 2015, 193 consecutive patients were included. The mean age was 9.2 ± 6.9 years (22% <1 year); 86 (45%) had a preceding balloon valvuloplasty. The indications for the procedure were stenotic (n = 123; 64%), regurgitant (n = 63; 33%) or combined (n = 7; 4%) disease. The procedures performed were commissurotomy shaving (n = 74; 38%), leaflet replacement (n = 78; 40%), leaflet extension (n = 21; 11%) and neocommissure creation (n = 21; 11%). Post-repair geometry was tricuspid in 137 (71%) patients.
The 10-year survival rate was 97.1%. Freedom from reoperation and replacement at 7 years was, respectively, 57% (95% confidence interval, 47-66) and 68% (95% confidence interval, 59-76). In multivariate analysis, balloon dilatation before 6 months, the absence of a developed commissure, a non-tricuspid post-repair geometry and cross-clamp duration were predictors for reoperation and replacement. After a mean follow-up period of 5.1 ± 3.0 years, 145 (75%) patients had a preserved native valve, with undisturbed valve function (peak gradient <40 mmHg, regurgitation ≤mild) in 113 (58%).
Aortic valve repair in children is safe and effective in delaying the timing for more definitive solution. Surgical strategy should be individualized according to the age of the patient. Avoidance of early balloon dilatation and aiming for a tricuspid post-repair arrangement may improve outcomes.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezx172</identifier><identifier>PMID: 28874025</identifier><language>eng</language><publisher>Germany</publisher><subject>Adolescent ; Adult ; Aortic Valve - abnormalities ; Aortic Valve - diagnostic imaging ; Aortic Valve - surgery ; Bicuspid Aortic Valve Disease ; Child ; Child, Preschool ; Disease Management ; Disease-Free Survival ; Echocardiography, Transesophageal ; Female ; Follow-Up Studies ; Forecasting ; Germany - epidemiology ; Heart Defects, Congenital - mortality ; Heart Defects, Congenital - surgery ; Heart Valve Diseases - congenital ; Heart Valve Diseases - mortality ; Heart Valve Diseases - surgery ; Heart Valve Prosthesis Implantation - methods ; Heart Valve Prosthesis Implantation - standards ; Humans ; Infant ; Infant, Newborn ; Male ; Practice Guidelines as Topic ; Reoperation - trends ; Retrospective Studies ; Survival Rate - trends ; Young Adult</subject><ispartof>European journal of cardio-thoracic surgery, 2017-09, Vol.52 (3), p.581-587</ispartof><rights>The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c395t-564a62a9277eb66e6ecdfd40bfd081db8ccd7de0e1e12737ea7fe49507cd3d7c3</citedby><cites>FETCH-LOGICAL-c395t-564a62a9277eb66e6ecdfd40bfd081db8ccd7de0e1e12737ea7fe49507cd3d7c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28874025$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vergnat, Mathieu</creatorcontrib><creatorcontrib>Asfour, Boulos</creatorcontrib><creatorcontrib>Arenz, Claudia</creatorcontrib><creatorcontrib>Suchowerskyj, Philipp</creatorcontrib><creatorcontrib>Bierbach, Benjamin</creatorcontrib><creatorcontrib>Schindler, Ehrenfried</creatorcontrib><creatorcontrib>Schneider, Martin</creatorcontrib><creatorcontrib>Hraska, Victor</creatorcontrib><title>Contemporary results of aortic valve repair for congenital disease: lessons for management and staged strategy</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>Any aortic valve (AoV) operation in children (repair, Ross or mechanical replacement) is a palliation and reinterventions are frequent. AoV repair is a temporary solution primarily aimed at allowing the patient to grow to an age when more definitive solutions are available. We retrospectively analysed AoV repair effectiveness across the whole age spectrum of children, excluding neonates and AoV disease secondary to congenital heart disease.
From 2003 to 2015, 193 consecutive patients were included. The mean age was 9.2 ± 6.9 years (22% <1 year); 86 (45%) had a preceding balloon valvuloplasty. The indications for the procedure were stenotic (n = 123; 64%), regurgitant (n = 63; 33%) or combined (n = 7; 4%) disease. The procedures performed were commissurotomy shaving (n = 74; 38%), leaflet replacement (n = 78; 40%), leaflet extension (n = 21; 11%) and neocommissure creation (n = 21; 11%). Post-repair geometry was tricuspid in 137 (71%) patients.
The 10-year survival rate was 97.1%. Freedom from reoperation and replacement at 7 years was, respectively, 57% (95% confidence interval, 47-66) and 68% (95% confidence interval, 59-76). In multivariate analysis, balloon dilatation before 6 months, the absence of a developed commissure, a non-tricuspid post-repair geometry and cross-clamp duration were predictors for reoperation and replacement. After a mean follow-up period of 5.1 ± 3.0 years, 145 (75%) patients had a preserved native valve, with undisturbed valve function (peak gradient <40 mmHg, regurgitation ≤mild) in 113 (58%).
Aortic valve repair in children is safe and effective in delaying the timing for more definitive solution. Surgical strategy should be individualized according to the age of the patient. Avoidance of early balloon dilatation and aiming for a tricuspid post-repair arrangement may improve outcomes.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aortic Valve - abnormalities</subject><subject>Aortic Valve - diagnostic imaging</subject><subject>Aortic Valve - surgery</subject><subject>Bicuspid Aortic Valve Disease</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Disease Management</subject><subject>Disease-Free Survival</subject><subject>Echocardiography, Transesophageal</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Forecasting</subject><subject>Germany - epidemiology</subject><subject>Heart Defects, Congenital - mortality</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Heart Valve Diseases - congenital</subject><subject>Heart Valve Diseases - mortality</subject><subject>Heart Valve Diseases - surgery</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Heart Valve Prosthesis Implantation - standards</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Practice Guidelines as Topic</subject><subject>Reoperation - trends</subject><subject>Retrospective Studies</subject><subject>Survival Rate - trends</subject><subject>Young Adult</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kDtPwzAURi0EoqWwMSOPDITacWInbKjiJVViAYktcu2bKlViB1-3ovx60haYvvs4-oZDyCVnt5yVYgorE3EK319cpUdkzAslEiWyj-NhZpwlqszYiJwhrhhjUqTqlIzSolAZS_MxcTPvInS9DzpsaQBctxGpr6n2ITaGbnS7geHe6ybQ2gdqvFuCa6JuqW0QNMIdbQHRO9z_O-30EjpwkWpnKcZh20XQEZbbc3JS6xbh4jcn5P3x4W32nMxfn15m9_PEiDKPSS4zLVNdpkrBQkqQYGxtM7aoLSu4XRTGWGWBAQeeKqFAqxqyMmfKWGGVERNyfejtg_9cA8aqa9BA22oHfo0VL4VMJZOKD-jNATXBIwaoqz403WCj4qzaGa72hquD4QG_-m1eLzqw__CfUvEDy5V8YA</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Vergnat, Mathieu</creator><creator>Asfour, Boulos</creator><creator>Arenz, Claudia</creator><creator>Suchowerskyj, Philipp</creator><creator>Bierbach, Benjamin</creator><creator>Schindler, Ehrenfried</creator><creator>Schneider, Martin</creator><creator>Hraska, Victor</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170901</creationdate><title>Contemporary results of aortic valve repair for congenital disease: lessons for management and staged strategy</title><author>Vergnat, Mathieu ; Asfour, Boulos ; Arenz, Claudia ; Suchowerskyj, Philipp ; Bierbach, Benjamin ; Schindler, Ehrenfried ; Schneider, Martin ; Hraska, Victor</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c395t-564a62a9277eb66e6ecdfd40bfd081db8ccd7de0e1e12737ea7fe49507cd3d7c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aortic Valve - abnormalities</topic><topic>Aortic Valve - diagnostic imaging</topic><topic>Aortic Valve - surgery</topic><topic>Bicuspid Aortic Valve Disease</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Disease Management</topic><topic>Disease-Free Survival</topic><topic>Echocardiography, Transesophageal</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Forecasting</topic><topic>Germany - epidemiology</topic><topic>Heart Defects, Congenital - mortality</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Heart Valve Diseases - congenital</topic><topic>Heart Valve Diseases - mortality</topic><topic>Heart Valve Diseases - surgery</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Heart Valve Prosthesis Implantation - standards</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Practice Guidelines as Topic</topic><topic>Reoperation - trends</topic><topic>Retrospective Studies</topic><topic>Survival Rate - trends</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vergnat, Mathieu</creatorcontrib><creatorcontrib>Asfour, Boulos</creatorcontrib><creatorcontrib>Arenz, Claudia</creatorcontrib><creatorcontrib>Suchowerskyj, Philipp</creatorcontrib><creatorcontrib>Bierbach, Benjamin</creatorcontrib><creatorcontrib>Schindler, Ehrenfried</creatorcontrib><creatorcontrib>Schneider, Martin</creatorcontrib><creatorcontrib>Hraska, Victor</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vergnat, Mathieu</au><au>Asfour, Boulos</au><au>Arenz, Claudia</au><au>Suchowerskyj, Philipp</au><au>Bierbach, Benjamin</au><au>Schindler, Ehrenfried</au><au>Schneider, Martin</au><au>Hraska, Victor</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Contemporary results of aortic valve repair for congenital disease: lessons for management and staged strategy</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>52</volume><issue>3</issue><spage>581</spage><epage>587</epage><pages>581-587</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><abstract>Any aortic valve (AoV) operation in children (repair, Ross or mechanical replacement) is a palliation and reinterventions are frequent. AoV repair is a temporary solution primarily aimed at allowing the patient to grow to an age when more definitive solutions are available. We retrospectively analysed AoV repair effectiveness across the whole age spectrum of children, excluding neonates and AoV disease secondary to congenital heart disease.
From 2003 to 2015, 193 consecutive patients were included. The mean age was 9.2 ± 6.9 years (22% <1 year); 86 (45%) had a preceding balloon valvuloplasty. The indications for the procedure were stenotic (n = 123; 64%), regurgitant (n = 63; 33%) or combined (n = 7; 4%) disease. The procedures performed were commissurotomy shaving (n = 74; 38%), leaflet replacement (n = 78; 40%), leaflet extension (n = 21; 11%) and neocommissure creation (n = 21; 11%). Post-repair geometry was tricuspid in 137 (71%) patients.
The 10-year survival rate was 97.1%. Freedom from reoperation and replacement at 7 years was, respectively, 57% (95% confidence interval, 47-66) and 68% (95% confidence interval, 59-76). In multivariate analysis, balloon dilatation before 6 months, the absence of a developed commissure, a non-tricuspid post-repair geometry and cross-clamp duration were predictors for reoperation and replacement. After a mean follow-up period of 5.1 ± 3.0 years, 145 (75%) patients had a preserved native valve, with undisturbed valve function (peak gradient <40 mmHg, regurgitation ≤mild) in 113 (58%).
Aortic valve repair in children is safe and effective in delaying the timing for more definitive solution. Surgical strategy should be individualized according to the age of the patient. Avoidance of early balloon dilatation and aiming for a tricuspid post-repair arrangement may improve outcomes.</abstract><cop>Germany</cop><pmid>28874025</pmid><doi>10.1093/ejcts/ezx172</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of cardio-thoracic surgery, 2017-09, Vol.52 (3), p.581-587 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Aortic Valve - abnormalities Aortic Valve - diagnostic imaging Aortic Valve - surgery Bicuspid Aortic Valve Disease Child Child, Preschool Disease Management Disease-Free Survival Echocardiography, Transesophageal Female Follow-Up Studies Forecasting Germany - epidemiology Heart Defects, Congenital - mortality Heart Defects, Congenital - surgery Heart Valve Diseases - congenital Heart Valve Diseases - mortality Heart Valve Diseases - surgery Heart Valve Prosthesis Implantation - methods Heart Valve Prosthesis Implantation - standards Humans Infant Infant, Newborn Male Practice Guidelines as Topic Reoperation - trends Retrospective Studies Survival Rate - trends Young Adult |
| title | Contemporary results of aortic valve repair for congenital disease: lessons for management and staged strategy |
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