Intermediate-term results of repair for aortic, neoaortic, and truncal valve insufficiency in children.
OBJECTIVE
Repair of aortic valve insufficiency is difficult, and durability is relatively unknown in children. This study evaluates the intermediate-term results of repair of the systemic semilunar valve, including the native aortic valve, neoaortic valve (anatomic pulmonary), and truncal valve.


METHODS
We reviewed the records of 54 children (aged 2 days to 18 years) who underwent repair of the functional aortic valve for moderate or greater insufficiency from 1991 to 2005. Valve anatomy was tricuspid aortic in 26 patients, bicuspid aortic in 11 patients, tricuspid neoaortic in 9 patients, bicuspid neoaortic in 1 patient, and truncal valve in 7 patients. Multiple surgical techniques were used in most of the 54 patients, including leaflet plication in 17, leaflet repair in 15, commissuroplasty in 32, pericardial cusp augmentation in 8, and sinus of Valsalva reduction in 3.


RESULTS
There was 1 early death and no late deaths. Actuarial freedom from reoperation was 68% at 5 years and 58% at 10 years. Freedom from aortic valve replacement was 82% at 5 years and 73% at 10 years. Duration of cardiopulmonary bypass was the most significant risk factor for reoperation with multivariate analysis. Of the 40 patients who have not undergone reoperation, 37 have had follow-up echocardiograms with the latest study (4.5 +/- 4.2 years) demonstrating trace to 1+ insufficiency in 23 patients, 1 to 2+ in 12 patients, 2 to 3+ in 1 patient, and 3 to 4+ in 1 patient.


CONCLUSIONS
Repair of the insufficient systemic semilunar valve offers acceptable 10-year freedom from reoperation and functional results, and should be considered for most children.
Hawkins
John A
JA
Division of Cardiothoracic Surgery, Department of Surgery, Primary Children's Medical Center, and the University of Utah, Salt Lake City, Utah 84113, USA. jhawkins@hsc.utah.edu
Kouretas
Peter C
PC
Holubkov
Richard
R
Williams
Richard V
RV
Tani
Lloyd Y
LY
Su
Jason T
JT
Lambert
Linda M
LM
Mart
Christopher R
CR
Puchalski
Michael D
MD
Minich
L LuAnn
LL
D000293:Adolescent; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011664:Pulmonary Valve / Q000002:abnormalities / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D014339:Truncus Arteriosus, Persistent / Q000601:surgery*