Long-Term Outcomes after Aortic Valve Repair in Pediatric Patients

Objectives: The study aim was to report on long-term outcomes after pediatric aortic valve repair. The primary endpoints were reoperation on the aortic valve and mortality.

Methods: A retrospective chart review of all patients aged below 18 years at time of surgery, who had undergone aortic valve repair from May 1985 until April 2020 was conducted. The study endpoints were compared between two groups: the commissurotomy group (52.2%; 71/136), which consisted of patients who underwent commissurotomy with/without leaflet shaving and the reconstruction group (47.8%; 65/136), which included leaflet perforation closure (suture and/or patch), types of leaflet free-edge shortening (plication), leaflet and/or commissural reconstruction (patch extension), neocommissure creation, leaflet plication, and annuloplasty. Mortality was cross-checked with the national health insurance database. Long-term survival status was established for 96% of the patients. Time-related events were assessed using the Kaplan–Meier estimator. Continuous variables were compared using the independent samples Mann–Whitney U-test.

Result: During the study period, 126 patients (69.8% male and 69.8% bicuspid valve) underwent 136 aortic valve repair surgeries. Aortic valve stenosis (66.2%) was the most frequent indication for surgery. Median age at time of surgery was 2.4 years (IQR: 0.2–10.1 years) and in 15.4% (n = 21) surgery was performed in neonates. In nine patients (6.6%), surgery was performed as an acute intervention. There were seven early deaths. All early deaths occurred in patients aged <1 year at time of surgery. Seven late deaths occurred and overall survival was 90.8 ± 2.7% at 10 years, 86.9 ± 3.3% at 20 years, and 83.5 ± 4.7% at 30 years. Overall freedom from reoperation on the aortic valve was 54.9 ± 4.8% at 10 years, 32 ± 5.3% at 20 years, and 25.6 ± 7.1% at 30 years. Freedom from reoperation on the aortic valve was not different (p = 0.798) between the commissurotomy group and the reconstruction group with freedom from reoperation rates of 33.9 ± 6.4 and 26.7 ± 10.1% at 20 years, respectively. Also, time to reoperation did not differ (p = 0.138) with a median time of 7.4 years (IQR: 2.8–12.4 years) and 4.9 years (IQR: 1.3–9.3 years).

Conclusion: Long-term outcomes after aortic valve repair in pediatric patients show encouraging results in delaying or avoiding valve replacement. Reoperation rates do not differ between solitary commissurotomy and more complex valve reconstruction.

Publication History

Article published online:
21 February 2021