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Updated: Sep 28, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Retrospective single-center historical comparative study between proGAV and proGAV2.0 for surgical revision and
E Brunner1, A Schaumann1, V Pennacchietti1
1Pediatric Neurosurgery, Charité Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Insights
The proGAV and proGAV2.0 valve systems showed similar revision-free survival rates for pediatric hydrocephalus shunts. However, the proGAV valve demonstrated a significantly longer implant duration in patients requiring valve-only revisions.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Biomedical Engineering
Background:
- Cerebrospinal fluid (CSF) diversion shunt systems are standard for pediatric hydrocephalus.
- Developing improved valve systems to prevent complications like occlusions and malpositioning is crucial.
Purpose of the Study:
- To compare the revision-free survival and isolated valve revision outcomes of the proGAV and proGAV2.0 valve systems.
- To evaluate the implant duration of these valve systems in pediatric hydrocephalus patients.
Main Methods:
- A retrospective historical comparison of shunt and valve revision-free survival rates over a 2-year period with 30-month follow-up.
- Analysis of isolated valve revisions and implant duration for both proGAV and proGAV2.0 systems.
Main Results:
- No statistically significant differences in shunt or valve revision-free survival rates between proGAV and proGAV2.0 over 30 months.
- Patients undergoing valve-only revisions showed a significantly longer implant duration with the proGAV system (961.9 days) compared to proGAV2.0 (601.4 days).
Conclusions:
- Both proGAV and proGAV2.0 valve systems exhibit comparable revision-free survival rates in pediatric hydrocephalus.
- While survival rates are similar, the proGAV system offers a longer implant duration for specific patient groups requiring valve-only revisions, suggesting potential benefits in certain scenarios.
Objective:
Cerebrospinal fluid (CSF) diversion shunt systems remain to be the most common treatment for pediatric hydrocephalus. Different valve systems are used to regulate CSF diversion. Preventing complications such as occlusions, ruptures, malpositioning, and over- or underdrainage are the focus for further developments. The proGAV and proGAV2.0 valve system are compared in this retrospective study for revision-free survival and isolated valve revision paradigms.
Methods:
In the first part of the study, the shunt and valve revision-free survival rates were investigated in a retrospective historical comparison design for a period of 2 years in which each valve was used as standard valve (proGAV: July 2012-June 2014; proGAV2.0: January 2015-December 2016) with subsequent 30-month follow-up period, respectively. In the second part of the study, the implant duration was calculated by detecting isolated valve (valve-only) revisions together with another valve explantation during the entire period of the first study and its follow-up period.
Results:
Two hundred sixty-two patients (145 male and 117 female, mean age 6.2 ± 6.1 years) were included in the cohort of revision-free survival. During the 30-month follow-up period, 41 shunt revisions, including 27 valve revisions (shunt survival rate: 72.1%, valve survival rate: 81.6%) were performed in the proGAV cohort and 37 shunt revisions, including 21 valve revisions (shunt survival rate: 74.8% and valve survival rate: 85.0%) were performed in the proGAV2.0 cohort without showing statistically significant differences. In the second part of the study, 38 cases (mean age 4.0 ± 3.9 years) met the inclusion criteria of receiving a valve-only-revision. In those patients, a total of 44 proGAV and 42 proGAV2.0 were implanted and explanted during the entire study time. In those, a significantly longer implant duration was observed for proGAV (mean valve duration 961.9 ± 650.8 days) compared to proGAV2.0 (mean length of implantation period 601.4 ± 487.8 days; p = 0.004).
Conclusion:
The shunt and valve revision-free survival rates were found to be similar among the groups during 30 month follow-up. In patients who received "valve only" revisions and a subsequent explanation, the implant duration was significantly longer in the proGAV. Although the amount of patients with valve-only-revisions are small compared to the entire cohort certain patients seem to be at higher risk for repeated valve revisions.
