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Selective tricuspidization and aortic cusp extension valvuloplasty: outcome analysis in infants and children

Anastasios C Polimenakos1, Shyam Sathanandam, Christopher Blair

  • 1Division of Pediatric Cardiovascular Surgery, The Heart Institute for Children at Advocate Hope Children's Hospital, Oak Lawn, Illinois, USA. anastasios_c_polimenakos@rush.edu

The Annals of Thoracic Surgery
|August 25, 2010
PubMed

Insights

Aortic cusp extension valvuloplasty is a durable, nonreplacement strategy for children with aortic valve disease, offering good long-term freedom from aortic valve replacement (AVR). This technique facilitates left ventricular reverse remodeling in pediatric patients.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Cardiac Surgery

Background:

  • Emerging aortic cusp extension valvuloplasty techniques offer nonreplacement strategies for younger patients with aortic insufficiency or stenosis.
  • Analysis of outcomes after aortic cusp extension valvuloplasty in infants and children was performed.

Purpose of the Study:

  • To evaluate the outcomes of aortic cusp extension valvuloplasty in pediatric patients.
  • To assess long-term freedom from aortic valve replacement (AVR) and identify determinants of outcome.

Main Methods:

  • Aortic cusp extension valvuloplasty, including pericardial cusp extension and tricuspidization, was performed on 78 patients younger than 10 years between 1987 and 2008.
  • Patients included those with bicuspid aortic valve, congenital aortic valve stenosis, or aortic insufficiency/stenosis, with some having prior valvuloplasty.
  • Median follow-up was 12.4 years, analyzing freedom from AVR.

Main Results:

  • No early or late deaths occurred.
  • Actuarial freedom from aortic valve replacement (AVR) at 1, 5, and 10 years was 97.3%, 71.3%, and 55.6%, respectively.
  • Left ventricular reverse remodeling was observed post-procedure.

Conclusions:

  • Aortic cusp extension valvuloplasty with tricuspidization provides satisfactory long-term durability and freedom from AVR in infants and children.
  • This technique is a reliable and effective approach for managing congenital or acquired abnormal aortic valves in pediatric populations.
  • The procedure allows for left ventricular reverse remodeling.
Abstract

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