Progression of Aortic Regurgitation After Different Repair Techniques for Congenital Aortic Valve Stenosis.
We sought to characterize the incidence of AR progression and determine risk factors for AR progression in a consecutive series of infants and children after surgical correction of congenital aortic valvular and supravalvular stenosis. N = 30 patients underwent repair of the aortic valve for isolated congenital aortic valve stenosis (n = 14, 47 %) or combined with aortic regurgitation (AR, n = 16, 53%). N = 27 (90%) had a valvular and n = 3 patients (10%) presented with supravalvular pathology of their aortic valve. In n = 16 patients (53%) a bicuspid and in n = 2 (6%) patients, a unicuspid valve was present. Comparative survival was analyzed using the Cox model and log-rank calculations. Log-rank calculations were performed for variables reaching statistical significance in order to identify differences in survival between groups. Commissurotomy was performed in n = 20 patients, patch implantation in n = 4, cusp shaving in n = 8, cusp prolapse correction in n = 3, and cusp augmentation in n = 4 patients. In patients with combined dysfunction and preoperative AR, AR was successfully reduced by the initial procedure, and postoperatively the overall median AR grade was 1+ (range 0-2.5+, p = 0.001, for AR reduction among patients with any grade of preoperative AR). By the time of follow-up echocardiography, the median AR grade had significantly progressed toward 1.5+ (p = 0.004). At the time of mid-term follow-up at 3.2 years, none of the patients had moderate or severe AR grades >2.5+. Patients with a monocuspid aortic valve and patients who had some kind of patch implantation into their cusps or commissures or shaving of thickened cusps were more likely to present with progression of aortic regurgitation. Monocuspid aortic valve and patch implantation, as well as cusp shaving, are probably linked to AR progression. The standard procedure of commissurotomy results in an absolute rate of AR progression of 40 % over a medium-term follow-up period.
Department of Cardiovascular Surgery, Heart Center Freiburg University, Hugstetter Strasse 55, 79106, Freiburg, Germany. fabian.alexander.kari@universitaets-herzzentrum.de.
Fabian A
FA
Kari
Department of Cardiovascular Surgery, Heart Center Freiburg University, Hugstetter Strasse 55, 79106, Freiburg, Germany.
Johannes
J
Kroll
Department of Cardiovascular Surgery, Heart Center Freiburg University, Hugstetter Strasse 55, 79106, Freiburg, Germany.
Jan
J
Kiss
Department of Cardiovascular Surgery, Heart Center Freiburg University, Hugstetter Strasse 55, 79106, Freiburg, Germany.
Carolin
C
Hess
Center for Pediatrics, University Medical Center Freiburg, Freiburg, Germany.
Brigitte
B
Stiller
Department of Cardiovascular Surgery, Heart Center Freiburg University, Hugstetter Strasse 55, 79106, Freiburg, Germany.
Matthias
M
Siepe
Department of Cardiovascular Surgery, Heart Center Freiburg University, Hugstetter Strasse 55, 79106, Freiburg, Germany.
Friedhelm
F
Beyersdorf
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000209:etiology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D012086:Reoperation; D012307:Risk Factors; D055815:Young Adult
Aortic valve regurgitation; Aortic valve repair; Bicuspid aortic valve; Congenital aortic valve stenosis; Monocuspid aortic valve