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Pediatric aortic valve repair: Any development in the material for cusp extension valvuloplasty?
Kelli Hu1, Umar Siddiqi1, Brian Lee2
1Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA.
Insights
Autologous pericardium demonstrated superior durability compared to CorMatrix for aortic valve repair in pediatric patients, showing a significantly lower reoperation rate over five years.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Aortic cusp extension is a critical aortic valve (AV) repair technique in pediatric patients.
- Material choice for AV repair impacts reoperation timelines.
- This study compares outcomes of pericardial versus synthetic repairs.
Purpose of the Study:
- To assess and compare short- and long-term postoperative outcomes of pediatric patients undergoing aortic cusp extension valvuloplasty.
- To evaluate the durability and reoperation rates associated with autologous pericardium versus CorMatrix repairs.
- To analyze the impact of repair material on aortic stenosis and regurgitation progression.
Main Methods:
- Retrospective single-center study of 38 pediatric patients (April 2009-July 2016).
- Comparison of autologous pericardium (n=30) versus CorMatrix (n=8) for aortic cusp extension valvuloplasty.
- Kaplan-Meier analysis for freedom from reoperation; assessment of aortic stenosis and regurgitation at baseline, postoperatively, and during follow-up.
Main Results:
- Five-year freedom from reoperation was significantly lower for CorMatrix (12.5%) than pericardium (62.5%) (p=0.01).
- Aortic regurgitation improved postoperatively in both groups but worsened at follow-up, with higher rates in the CorMatrix group (88%) compared to pericardium (70%).
- A significant decrease in trans-valvar gradient was observed postoperatively, with no significant change at follow-up.
Conclusions:
- Autologous pericardium may offer superior long-term durability for aortic valve repair using the cusp extension technique compared to CorMatrix.
- Material selection is crucial for optimizing outcomes in pediatric aortic valve repair.
- Further research is warranted to understand the long-term performance of synthetic materials in pediatric AV repair.
Background:
Aortic cusp extension is a technique for aortic valve (AV) repairs in pediatric patients. The choice of the material used in this procedure may influence the time before reoperation is required. We aimed to assess postoperative and long-term outcomes of patients receiving either pericardial or synthetic repairs.
Methods:
We conducted a single-center, retrospective study of pediatric patients undergoing aortic cusp extension valvuloplasty (N = 38) with either autologous pericardium (n = 30) or CorMatrix (n = 8) between April 2009 and July 2016. Short- and long-term postoperative outcomes were compared between the two groups. Freedom from reoperation was compared using Kaplan-Meier analysis. Degree of aortic stenosis (AS) and aortic regurgitation (AR) were recorded at baseline, postoperatively, and at outpatient follow-up.
Results:
At 5 years after repair, freedom from reoperation was significantly lower in the CorMatrix group (12.5%) compared to the pericardium group (62.5%) (p = .01). For the entire cohort, there was a statistically significant decrease in the peak trans-valvar gradient between preoperative and postoperative assessments with no significant change at outpatient follow-up. In the pericardium group, 28 (93%) had moderate to severe AR at baseline which improved to 11 (37%) postoperatively and increased to 21 (70%) at time of follow-up. In the biomaterial group, eight (100%) had moderate to severe AR which improved to three (38%) postoperatively and increased to seven (88%) at time of follow-up.
Conclusion:
In terms of durability, the traditional autologous pericardium may outperform the new CorMatrix for AV repairs using the cusp extension method.
