Progression of Aortic Regurgitation After Different Repair Techniques for Congenital Aortic Valve Stenosis

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• 作者：Fabian A. Kari ; Johannes Kroll ; Jan Kiss ; Carolin Hess…
• 关键词：Congenital aortic valve stenosis ; Aortic valve repair ; Bicuspid aortic valve ; Monocuspid aortic valve ; Aortic valve regurgitation
• 刊名：Pediatric Cardiology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：37
• 期：1
• 页码：84-89
• 全文大小：399 KB
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• 作者单位：Fabian A. Kari (1)
  Johannes Kroll (1)
  Jan Kiss (1)
  Carolin Hess (1)
  Brigitte Stiller (2)
  Matthias Siepe (1)
  Friedhelm Beyersdorf (1)
  
  1. Department of Cardiovascular Surgery, Heart Center Freiburg University, Hugstetter Strasse 55, 79106, Freiburg, Germany
  2. Center for Pediatrics, University Medical Center Freiburg, Freiburg, Germany
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Cardiology
  Cardiac Surgery
  Vascular Surgery
  
• 出版者：Springer New York
• ISSN：1432-1971

文摘

We sought to characterize the incidence of AR progression and determine risk factors for AR progression in a consecutive series of infants and children after surgical correction of congenital aortic valvular and supravalvular stenosis. N = 30 patients underwent repair of the aortic valve for isolated congenital aortic valve stenosis (n = 14, 47 %) or combined with aortic regurgitation (AR, n = 16, 53 %). N = 27 (90 %) had a valvular and n = 3 patients (10 %) presented with supravalvular pathology of their aortic valve. In n = 16 patients (53 %) a bicuspid and in n = 2 (6 %) patients, a unicuspid valve was present. Comparative survival was analyzed using the Cox model and log-rank calculations. Log-rank calculations were performed for variables reaching statistical significance in order to identify differences in survival between groups. Commissurotomy was performed in n = 20 patients, patch implantation in n = 4, cusp shaving in n = 8, cusp prolapse correction in n = 3, and cusp augmentation in n = 4 patients. In patients with combined dysfunction and preoperative AR, AR was successfully reduced by the initial procedure, and postoperatively the overall median AR grade was 1+ (range 0–2.5+, p = 0.001, for AR reduction among patients with any grade of preoperative AR). By the time of follow-up echocardiography, the median AR grade had significantly progressed toward 1.5+ (p = 0.004). At the time of mid-term follow-up at 3.2 years, none of the patients had moderate or severe AR grades >2.5+. Patients with a monocuspid aortic valve and patients who had some kind of patch implantation into their cusps or commissures or shaving of thickened cusps were more likely to present with progression of aortic regurgitation. Monocuspid aortic valve and patch implantation, as well as cusp shaving, are probably linked to AR progression. The standard procedure of commissurotomy results in an absolute rate of AR progression of 40 % over a medium-term follow-up period. Keywords Congenital aortic valve stenosis Aortic valve repair Bicuspid aortic valve Monocuspid aortic valve Aortic valve regurgitation