title: Long-term results of a strategy of aortic valve repair in the pediatric population.
abstract: OBJECTIVE
  To determine rate of reoperation subsequent to primary valve repair in a pediatric population.
  
  
  METHODS
  Between 1996 and 2009, 142 consecutive patients underwent aortic valve repair in our institution. Median age at surgery was 9 years, with 30 being younger than age 1 year. Indication for surgery was stenosis (n = 76), regurgitation (n = 55), and both (n = 11). Forty-six patients underwent repair with no addition of patch, whereas 96 patients required addition of patches of glutaraldehyde preserved autologous pericardium for cusp extension (n = 51) and other repair (n = 45).
  
  
  RESULTS
  In the early postoperative period after cusp extension repair, 2 patients had a sudden unexplained death and 1 had cardiac arrest requiring mechanical support and heart transplantation. Two additional patients with cusp extension displayed signs of coronary ischemia. After a mean follow-up of 3.4 ± 3.5 years, only 1 patient died of a noncardiac cause. Seven-year freedom from reoperation was 80% (95% confidence interval [CI], 66-89). By multivariate analysis, the only predictors of reintervention were cusp extension (hazard ratio [HR], 5.4; 95% CI, 1.7-16.8; P = .004) and infants (HR, 5.6; 95% CI, 1.7-18.4; P = .005). At final echocardiography follow-up, 23 of 119 survivors without reoperation had moderate (19%), 1 had moderate-severe (1%), and 1 had severe regurgitation (1%), whereas 12 (10%) had a moderate degree of stenosis.
  
  
  CONCLUSIONS
  Aortic valve repair in pediatric populations is effective in postponing reintervention. The longevity of the repair is shorter after cusp extension and when performed in infants. Caution should be used when performing tricsupidization and cusp extension of bicuspid valves because it can be responsible for mortality related to occlusion of the coronary ostia by patches.
authors.affiliation: Department of Cardiac Surgery, Royal Children’s Hospital, Flemington Rd, Parkville, Melbourne 3052, Victoria, Australia. yves.dudekem@rch.org.au
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
authors.forename: Javariah
authors.initials: J
authors.lastname: Siddiqui
authors.forename: Cameron S
authors.initials: CS
authors.lastname: Seaman
authors.forename: Igor E
authors.initials: IE
authors.lastname: Konstantinov
authors.forename: John C
authors.initials: JC
authors.lastname: Galati
authors.forename: Michael M H
authors.initials: MM
authors.lastname: Cheung
authors.forename: Christian P
authors.initials: CP
authors.lastname: Brizard
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001021:Aortic Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D017548:Echocardiography, Transesophageal; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D010496:Pericardium / Q000637:transplantation; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult