Aortic Valve Neocuspidization In A Pediatric Population: An Early Single Center Experience
David Blitzer, Anna Olds, Phillip Allen, Damien LaPar, Anne Ferris, David Solowiejczyk, Patrick Flynn, Maria Thanjan, Prema Ramaswamy, Emile Bacha, David Kalfa.
Columbia University, New York, NY, USA.
Introduction: Aortic valve (AV) neocuspidization (AVNeo) has been described in small pediatric series. We describe our pediatric experience with AVNeo. Methods: All patients undergoing AVNeo between 2018 and 2021 were included. Results: There were 17 patients included (male=13). Median weight was 65.4±20.8 (18.8-89.5) kg. Aortic insufficiency (AI) was the lesion in 10 patients, aortic stenosis (AS) in 5 and mixed in 2. Prior AV interventions included balloon valvuloplasty (n=4), aortic switch (n=1), and Ross (n=1). Autologous pericardium (n=13), Photofix (Cryolife, Kennesaw GA, USA)(n=3), and CardioCel (n=1)(LeMaitre Vascular, Burlington MA) were used. On discharge, all patients except one had ≤mild AI/AS. One patient had mild-moderate AI/AS. There was no in-hospital mortality and no follow-up mortality. One patient developed early dynamic obstruction of the left coronary artery and underwent a mechanical valve replacement. Median follow-up was 1.4±0.7 years (range 0.2-2.5). AV reoperation was required for 3 patients, one experienced dehiscence of a Photofix patch six weeks postoperatively and underwent redo AVNeo. One developed progressive AI with severe left ventricular dilation and underwent bioprosthetic AVR 2.3 years after AVNeo. Another developed bacterial endocarditis at 0.5 years and underwent bioprosthetic AVR. At last follow-up, median mean gradient was 16 mmHg (3-18). One of 14 patients developed AI>moderate. All other patients (n=13) had AI≤moderate (Fig 1).Conclusion: AVNeo is feasible in the pediatric population. Long-term multicentric studies are mandatory for validation.
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