Early experience using quantitative guidelines for aortic valve repair in pediatric patients

Pediatric aortic valve repair has traditionally been guided by qualitative assessment. In this study, we present our early experience using quantitative guidelines to inform repair.

We present a simple model of normal aortic valve proportions and compare outcomes of valves repaired with and without model-based guidelines. In a secondary analysis of a subset of valves that preoperatively exhibited 2 or 3 distinct leaflets with normal commissures, we assess whether achieving target normal leaflet free edge lengths is associated with less regurgitation.

Valve repair aided by modeling exhibited similar rates of aortic regurgitation (AR) and aortic stenosis (AS) on discharge and follow-up echocardiograms to controls. The repair versus replacement rate increased significantly from 57% in controls to 71% during the period in which modeling was used (P = .009), and the proportion of nontricuspid valves and the severity of preoperative AR was higher in the modeling groups than in the controls (P = .049 and P = .001, respectively). In the secondary analysis, operatively changing relative free edge length toward normal target values was associated with significant decreases in AR (P < .001), with a clear boundary separating valves with moderate or severe AR from those with none or trivial.

Use of quantitative repair guidelines achieved similar outcomes and higher repair rates despite higher preoperative valve complexity. Among valves with distinct leaflets and normal commissures, changes in AR from preoperation to postoperation closely tracked surgical changes to relative leaflet free edge length. Although initial results are promising, larger numbers and longer follow-up are needed.