Age-adjusted long-term outcomes of aortic valve repair in children

Objective. To analyze the age-adjusted long-term results of aortic valve (AV) repair in children of different age groups (<10 years and >10 years) excluding neonates, secondary AV repair and conotruncal heart defects. Material and methods. Effectiveness of AV repair was studied in 106 (65.1%) children aged <10 years (group 1) and 57 (34.9%) children aged >10 years (group 2). In group 1, indications for surgery were aortic insufficiency (AI), aortic stenosis (AS) and combined disease in 70 (66.0%), 12 (11.3%) and 24 (22.7%) patients, respectively. In the 2nd group, these lesions were observed in 26 (45.6%), 10 (17.6%) and 21 (36.8%) patients, respectively. AV repair was performed for isolated AI and predominant AI in patients with combined AV lesion. Commissurotomy and leaflet decalcification were used for isolated aortic stenosis. The Ozaki procedure was performed in patients with combined lesion of unicuspid AV or enlarged aortic annulus. Combined primary end-point was freedom from redo surgery and AS/AI >2. Results. Peak (p<0.001) and mean pressure gradient (p<0.001), as well as AI (in patients <10 years p<0.001, in patients >10 years p=0.014) decreased in all cases. Free edge plication, subcommissural annuloplasty and commissurotomy with decalcification are effective in children <10 years. Other two methods (raphe shaving and Trusler technique) are equally less effective, while cusp augmentation and replacement are followed by poor long-term results. In children >10 years, all techniques excluding cusp augmentation and Trusler technique demonstrate ≥70% freedom from combined endpoint in long-term follow-up period. The Ozaki procedure was effective throughout 2-year follow-up in all cases. Conclusion. Aortic valve repair is effective in different age groups for postponing valve replacement. This approach provides further growth of aortic root. Age-oriented surgical strategy may contribute to better long-term outcomes of AV repair.