Aortic valve repair using aortic wall as leaflet patch material in children

Background

Aortic valve repair (AVr) exhibits acceptable outcomes in children with adequate native tissue. With deficient leaflets, patch augmentation is often required. Autologous pericardium (AP) calcification precipitates cusp immobility and high failure rates. Alternatively, the use of aortic wall (AW) as leaflet patch material was assessed.

Methods

Between January 2023 and July 2024, 38 children underwent AVr using bicuspidization (n = 29; 76%) or another technique with AW (n = 19) or AP (n = 19) patches. Concurrent reduction ascending aortoplasty was performed more often in AW (n = 18 [95%] vs 10 [53%] for AP; P = .008). Primary endpoints were AoV reoperation and/or recurrent >mild aortic regurgitation (AR).

Results

Hospital stay, complications, and predischarge reoperation (3 AW, 2 AP) were similar in the 2 groups. There were no deaths in either group. At discharge, the AW and AP groups had a similar rate of >mild AR (19% vs 6%; P = .34), but the AW group had a >30% lower incidence of >trivial AR (25% vs 59% for AP; P = .08). At a median follow-up of 10.2 months, there were no additional reoperations in the AW group but 3 (16%) in the AP group (P = .61). On follow-up echocardiography at a median of 5.4 months, the rate of >mild AR was 23% in the AW group versus 24% in the AP group (P = .59). At 8 months postoperatively, for the AW and AP groups, freedom from reoperation was 84.2% versus 79.0% (P = .61), recurrent >mild AR was 82.8% versus 78.6% (P = .45), and the composite of reoperation and recurrent AR was 68.4 versus 73.7% (P = .61).

Conclusions

Pediatric AVr using AW as leaflet patch material has similar short-term outcomes as AP. Given the potential advantages of using a living autologous cardiovascular material, AW patches for AVr may demonstrate superior valve performance and durability with longer-term follow-up and expand options for valves previously thought to be unrepairable.