Aortic valve repair in the paediatric population: insights from a 38-year single-centre experience.
OBJECTIVE
To analyse our institutional results in the setting of paediatric aortic valve (AV) repair. Primary end-points were overall survival, freedom from AV reoperation and freedom from AV replacement.


METHODS
A retrospective analysis of all patients under 18 years of age operated on from 1977 to 2015 in a single tertiary care level institution. Patients were included if they benefited from any type of AV repair procedure, including commissurotomy, leaflet shaving or plication, or leaflet augmentation. All data were gathered from patients' medical records, operative reports and referring paediatric cardiologists. The median follow-up was 50 months (IQR [13-140]).


RESULTS
Sixty-six patients were included. Indications for surgery were aortic stenosis, aortic regurgitation and mixed disease in 13 (19%), 36 (55%) and 17 (26%) patients, respectively. According to El Khoury's functional classification, among the 55 patients with some degree of regurgitation there were 5 type Ib regurgitation, 23 type II and 27 type III. During AV repair, additional procedures were performed in 36 patients, VSD closure, subaortic membrane resection and mitral valve repair being the most frequent (18, 8 and 7 patients). RACHS score was predominantly 2 (98.5% of patients). The in-hospital mortality rate was 1.5% (1/66). Major morbidity included 10 pericardial effusions (1 pericardocentesis), 1 low cardiac output syndrome and 1 stroke. There were three late deaths (at 104, 140 and 179 months after repair). All were cardiac related. Overall 5- and 10-year survival rates were 100 and 95.7%. The rates of freedom from AV reoperation and AV replacement at 5 and 10 years were 90.6, 72.1 and 92.5, 82.7%, respectively. During follow-up, there was no occurrence of valve-related complication (endocarditis, thromboembolism and bleeding).


CONCLUSIONS
In our experience, AV repair in the paediatric population provides excellent results in terms of both overall survival and valve-related reoperation. It obviates the need for chronic anticoagulation and in most cases delays the time at which more complex surgery such as the Ross procedure should be undertaken.
Department of Cardiovascular and Thoracic Surgery, UCL-Cliniques Universitaires Saint-Luc, Brussels, Belgium alain.poncelet@uclouvain.be.
Alain J
AJ
Poncelet
Department of Cardiovascular and Thoracic Surgery, UCL-Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Gébrine
G
El Khoury
Department of Cardiovascular and Thoracic Surgery, UCL-Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Laurent
L
De Kerchove
Department of Pediatric Cardiology, UCL-Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Thierry
T
Sluysmans
Department of Pediatric Cardiology, UCL-Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Stéphane
S
Moniotte
Department of Anesthesiology, UCL-Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Mona
M
Momeni
Department of Pediatric Intensive Care, UCL-Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Thierry
T
Detaille
Department of Cardiovascular and Thoracic Surgery, UCL-Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Jean E
JE
Rubay
D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001530:Belgium / Q000453:epidemiology; D005500:Follow-Up Studies; D005544:Forecasting; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
Aortic valve repair; CHD; Paediatric