Contemporary Surgical Approaches in Pediatric Aortic Valve Surgery: A Retrospective Comparison of Three Techniques

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
R. N. Komarov, D. V. Shumakov, I. I. Chernov, V. A. Belov, V. A. Chragyan, A. M. Ismailbaev, B. M. Tlisov, S. T. Enginoev, B. K. Kadyraliev, V. P. Didyk, M. V. Tarayan, N. O. Kurasov, D. M. Abzalova, Owusu Richmond
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引用次数: 0

Abstract

Background: Congenital aortic valve (AV) disease is viewed in 2% of the population and in 20 out of 1000 neonates are presented with bicuspid configuration. Treatment of the congenital AV diseases requires multiple interventions. The ultimate goal is to provide adequate close to physiological left ventricle outflow and minimization of regurgitation. The optimal operative management of AV disease in children and young adults remains controversial. AV neocuspidization with glutaraldehyde-treated autologous pericardium may be a satisfactory alternative in pediatric cardiac surgery.

Objectives: The data of the AVNeo procedure results enable a comparative analysis of various AV reconstructive approaches in the pediatric cohort. In this article, we present the comparative study of various techniques in pediatric AV surgery, including the immediate and midterm outcomes of AVNeo, commissurotomy with aortic leaflet augmentation using pericardial patch (“free style” technique), and Ross procedure.

Study Design: We conducted a retrospective analysis of the early and midterm results of surgical AV disease treatment of 44 children in 5 cardiac surgery centers from 2014 to 2022. The patients were divided into 3 groups: group I: glutaraldehyde-treated autologous pericardium AVNeo (n = 12), group II: “free style” technique (n = 10), and group III: Ross procedure (n = 22). We described the immediate and midterm outcomes. The study design was approved by the ethics committees of the participating centers.

Results: A total of 44 children after surgical treatment of the AV disease in 5 cardiac surgery centers were included in the study and were grouped as group I: AVNeo (n = 12), group II: “free style” technique (n = 10), and group III: Ross procedure (n = 22). The median follow-up period was 57 ± 23.8 months. In-hospital mortality was 4.5% (n = 2). In the midterm follow-up, the peak pressure gradient was 18.45 ± 4.63 mmHg for group I and 8.9 ± 1.6 mmHg for group III (p = 0.00001), respectively. The cumulative freedom from reoperations was 100%, 30%, and 95.2% for 40 months of follow-up and 100%, 30%, and 83.4% for 70 months of follow-up in I, II, and III groups, respectively. No cases of midterm mortality were detected in all groups.

Conclusion: The AV neocuspidization with glutaraldehyde-treated autologous pericardium has an enormous advantage in pediatric AV surgery, significantly surpassing the freedom from resurgery of repair procedures and having comparable results with the Ross procedure in the midterm follow-up.

Abstract Image

小儿主动脉瓣手术的当代手术方法:三种技术的回顾性比较
背景:先天性主动脉瓣(AV)疾病的发病率占总人口的 2%,每 1000 个新生儿中就有 20 个呈现双尖瓣结构。先天性房室疾病的治疗需要多种干预措施。最终目标是提供足够接近生理的左心室流出物,并最大限度地减少反流。儿童和青少年房室疾病的最佳手术治疗方法仍存在争议。在小儿心脏手术中,使用戊二醛处理的自体心包进行房室新瓣成形术可能是一种令人满意的替代方法。 目标:通过 AVNeo 手术的结果数据,我们可以对小儿群体中的各种房室重建方法进行比较分析。在本文中,我们对小儿房室手术中的各种技术进行了比较研究,包括 AVNeo、使用心包补片的主动脉瓣叶增大术("游离式 "技术)和 Ross 手术的近期和中期疗效。 研究设计:我们对2014年至2022年期间5个心脏外科中心44名儿童的手术治疗房室疾病的早期和中期结果进行了回顾性分析。患者分为三组:第一组:戊二醛处理的自体心包AVNeo(12人);第二组:"游离式 "技术(10人);第三组:Ross手术(22人)。我们对近期和中期结果进行了描述。研究设计获得了参与中心伦理委员会的批准。 研究结果共有 44 名儿童在 5 个心脏外科中心接受了房室疾病手术治疗,并被分为 I 组:AVNeo(12 人)、II 组:"自由式 "技术(10 人)和 III 组:Ross 手术(22 人)。中位随访时间为 57 ± 23.8 个月。院内死亡率为 4.5%(n = 2)。在中期随访中,第一组和第三组的峰值压力梯度分别为 18.45 ± 4.63 mmHg 和 8.9 ± 1.6 mmHg(P = 0.00001)。I 组、II 组和 III 组在 40 个月的随访中累计免于再次手术的比例分别为 100%、30% 和 95.2%,在 70 个月的随访中分别为 100%、30% 和 83.4%。各组均未发现中期死亡病例。 结论使用戊二醛处理过的自体心包进行房室新生术在小儿房室手术中具有巨大优势,其免再手术率明显高于修复手术,中期随访结果与 Ross 手术相当。
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来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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