Key result
Confluent aortic valve neocuspidization reduces peak gradient by ~55 mmHg, but midterm outcomes remain suboptimal.
Why the study?
The treatment of aortic valve diseases in children remains a great challenge.
Does the confluent aortic valve neocuspidization technique with pericardium improve echocardiographic parameters and clinical outcomes in children requiring aortic valve replacement?
Cohort (n=20)
No
Does the confluent aortic valve neocuspidization technique with pericardium improve echocardiographic parameters and clinical outcomes in children requiring aortic valve replacement?
The confluent aortic valve neocuspidization technique with pericardium offers immediate hemodynamic relief for pediatric aortic valve disease, but midterm follow-up reveals suboptimal durability and potential need for reintervention.
Answers are grounded in this paper and cite their sources.
May warrant caution before routine use in children; leaves open durability and need for prospective trials.
Background: The treatment of aortic valve diseases in children remains a great challenge. We aim to report outcomes and midterm follow-up data of our confluent neocuspidization technique with pericardium for aortic valve replacement (AVR) in children. Methods: A retrospective analysis was performed on all 20 children who underwent the confluent neocuspidization technique with pericardium at Children's Hospital of Fudan University from March 2017 to May 2022. Outcome measures included echocardiographic measurements, surgical intervention, and mortality. Results: 3 females), with a median age of 7.5 years [min-max, 0.3-12 years; interquartile range (IQR), 4.4-9.7 years], a median body weight of 24.0 kg (min-max, 6.0-52.3 kg; IQR, 15.6-31.0 kg), and median aortic valve annulus size before surgery of 19.0 mm (min-max, 11.0-25.0 mm; IQR, 17.1-21.5 mm), underwent the neocuspidization technique with pericardium (17 autologous pericardia and 3 bovine patch). With 50% of bicuspid aortic valve and 50% of tricuspid, they were respectively diagnosed as aortic stenosis (AS) (7/20, 35%), aortic regurgitation (AR) (8/20, 40%) and mixed AS and AR (AS & AR) (5/20, 25%). The median postoperative follow-up time was 19 months (min-max, 5-61 months; IQR, 16.3-35 months). The peak pressure gradient across the aortic valve decreased from 81.0±37.0 mmHg in AS group and AS & AR group before surgery to 25.9±15.8 mmHg within 24 hours after surgery (P<0.001) and was mostly around 25 mmHg during follow-up. All patients presented mild or less than mild regurgitation within 24 hours after surgery. There were no hospital mortalities. Three patients needed reintervention during follow-up. There was one late death related to mitral valve stenosis. Conclusions: Though the confluent neocuspidization technique with pericardium provided immediate relief of significant AS or regurgitation, the midterm outcome was suboptimal. More research is needed to find the optimal material for AVR.
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Huang et al. (2023) conducted a cohort in Aortic valve disease (aortic stenosis, aortic regurgitation) (n=20). Confluent neocuspidization technique with pericardium vs. Baseline (before surgery) was evaluated on Peak pressure gradient across the aortic valve in AS and AS & AR groups (mmHg) (p=<0.001). The confluent aortic valve neocuspidization technique with pericardium reduced peak pressure gradient from 81.0 to 25.9 mmHg, though midterm outcomes were suboptimal requiring three reinterventions.
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