Progression of Aortic Regurgitation After Different Repair Techniques for Congenital Aortic Valve Stenosis
| Autor: | Matthias Siepe, Brigitte Stiller, Friedhelm Beyersdorf, Jan Kiss, Carolin Hess, Fabian A. Kari, Johannes Kroll |
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| Rok vydání: | 2015 |
| Předmět: |
Aortic valve
Adult Male Reoperation medicine.medical_specialty Adolescent Aortic Valve Insufficiency Kaplan-Meier Estimate 030204 cardiovascular system & hematology 03 medical and health sciences Young Adult 0302 clinical medicine Bicuspid aortic valve Aortic valve repair Risk Factors Internal medicine medicine Humans Cardiac Surgical Procedures Child Aortic valve regurgitation business.industry Infant Aortic Valve Stenosis medicine.disease Cardiac surgery Surgery Stenosis medicine.anatomical_structure 030228 respiratory system Echocardiography Aortic Valve Child Preschool Pediatrics Perinatology and Child Health cardiovascular system Cardiology Disease Progression Female Unicuspid Cardiology and Cardiovascular Medicine Commissurotomy business |
| Zdroj: | Pediatric cardiology. 37(1) |
| ISSN: | 1432-1971 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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