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Long-Term Results of Repair For Aortic, neo-Aortic and Truncal Valve Insufficiency in Children
J. A. Hawkins*, P. C. Kouretas, R. V. Williams, L. Y. Tani, L. M. Lambert, C. R. Mart, J. T. Su, M. D. Puchalski, L. L. Minich. Primary Children's Medical Center, Salt Lake City, UT,
BACKGROUND: Reliable repair of aortic valve (AV) insufficiency is difficult and long-term durability is unknown in children. This study evalutates long-term results of repair of the systemic semilunar valve , including the AV, neo-AV and truncal valve.
METHODS: Fifty-five children (age 2 days - 18 yrs) underwent repair of the functional AV for severe valve insufficiency from 1991 to 2005. Anatomy included trileaflet AV (31), bicuspid AV (9), tricuspid neo-AV (anatomic pulmonary valve,8) and truncal valve (7). Surgical techniques were multiple in most of the 55 patients and included leaflet plication (17), leaflet repair (15), commissuroplasty (39), leaflet augmentation (7), circumferential annuloplasty (6) and sinus of valsalva plasty (3).
RESULTS: There was one early death and no late deaths. Actuarial freedom from reoperation was 98% at 1 yr, 68% at 5 yrs, and 59% at 10 yrs. Actuarial freedom from valve replacement was 100% at 1 yr, 82% at 5 yrs, and 68% at 10 yrs. The reoperation rate was not significantly different between AVs, neo-AVs or truncal valves. Echocardiography a mean of 55 mos. post repair in 36 of the 41 pts not undergoing reoperation, revealed trace or less AI in 19% (7/36), mild in 64% (23/36), moderate in 14% (5/36) and severe in 3% (1/36).
CONCLUSIONS: Repair of the systemic semilunar valve requires an individualized approach tailored to the anatomic cause of the insufficiency. Repair of the insufficient aortic valve, neo-AV or truncal valve offers acceptable 10-year freedom from reoperation and functional results in children.
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