Aortic Valve Repair In Pediatric Patients: Is There Any Development In The Material For Aortic Cusp Extension Valvuloplasty?
Kelli Hu1, Umar Siddiqi1, Brian Lee, MD2, Emily Pena, PA-C2, Kelci Schulz, DO2, Maggie Vogel, DO2, Pamela Combs, PhD, RN1, Chawki El-Zein, MD2, Michel Ilbawi, MD2, Luca Vricella, MD2, Narutoshi Hibino, MD, PhD1.
1UChicago Medicine, Chicago, IL, USA, 2Advocate Children’s Hospital, Pediatric Cardiology, Oak Lawn, IL, USA.
Objective(s): We aimed to assess post-operative and long-term outcomes of pediatric patients receiving either pericardial or synthetic materials during aortic valve (AV) repair.
Methods: We conducted a single center, retrospective study of pediatric patients undergoing aortic cusp extension valvuloplasty (N=38) with either autologous pericardium (n=30) or CorMatrix (n=8) between April 2009 and July 2016. Short and long-term postoperative outcomes were compared between the two groups. Freedom from re-operation was compared using Kaplan Meier analysis. Degree of aortic stenosis (AS) and aortic regurgitation (AR) were recorded at baseline, post- operatively, and at outpatient follow-up.
Results: At five years after repair, freedom from re-operation was significantly lower in the CorMatrix group (12.5%) compared to the pericardium group (62.5%) (P = 0.01). For the entire cohort, there was a statistically significant decrease in the peak trans- valvar gradient between pre- and post-operative assessments with no significant change at outpatient follow-up. In the pericardium group, 28 (93%) had moderate to severe AR at baseline which improved to 11 (37%) post-operatively and increased to 21 (70%) at time of follow-up. In the CorMatrix group, 8 (100%) had moderate to severe AR which improved to 3 (38%) post-operatively and increased to 7 (88%) at time of follow-up.
Conclusions: In terms of durability, the traditional autologous pericardium may outperform the new material (CorMatrix) for AV repair using the cusp extension method.
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