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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Multicentre comparative analysis of long-term outcomes after aortic valve replacement in children

Jessica H Knight1, Amber Leila Sarvestani2, Chizitam Ibezim2

  • 1Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA jessica.knight@uga.edu.

Heart (British Cardiac Society)
|October 6, 2021
PubMed

Insights

Pulmonic valve autografts offer superior long-term survival for children with aortic valve disease compared to mechanical valves. Treatment center experience may also influence outcomes after aortic valve replacement.

Area of Science:

  • Pediatric Cardiology
  • Cardiac Surgery
  • Biomaterials Science

Background:

  • Congenital aortic valve disease necessitates surgical intervention in children.
  • The optimal prosthetic valve for pediatric aortic valve replacement (AVR) remains debated.
  • Long-term outcome data (beyond 10-15 years) for pediatric AVR substitutes are limited.

Purpose of the Study:

  • To evaluate up to 25-year transplant-free survival after aortic valve replacement in children based on valve substitute type.
  • To assess the impact of treatment center volume and experience on AVR outcomes.
  • To compare the survival rates of pulmonic valve autografts versus mechanical prosthetic valves.

Main Methods:

  • Retrospective cohort study utilizing the Pediatric Cardiac Care Consortium registry.
  • Inclusion of children (0-20 years) undergoing AVR between 1982 and 2003.
  • Linkage with National Death Index and United Network for Organ Sharing for long-term follow-up through 2019.
  • Kaplan-Meier analysis for transplant-free survival and Cox proportional hazard models for risk assessment.

Main Results:

  • A total of 911 children underwent AVR, with a median age of 13.4 years.
  • Twenty-five-year transplant-free survival was highest for pulmonic valve autograft (87.1%), followed by mechanical AVR (76.2%) and tissue valves (72.0%).
  • Mechanical AVR was associated with significantly increased mortality/transplant risk compared to autograft (HR=1.9).
  • Lower survival for mechanical AVR, but not autograft, was observed in centers with higher in-hospital mortality.

Conclusions:

  • Pulmonic valve autograft is associated with the best long-term transplant-free survival in pediatric patients undergoing aortic valve replacement.
  • The choice of valve substitute and treatment center characteristics significantly impact long-term outcomes.
  • Further research into patient selection and center experience is warranted to optimize AVR results in children.
Abstract

Keywords:
congenital abnormalitiesheart valve prosthesis

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