Aortic Valve Interventions in Pediatric Patients

Truncal valve repair and other aortic pediatric valves

“…It avoids the long-term risks of anticoagulation, allows growth and postpones AVR to an older age where a more definite AV substitute could be implanted. In the last decade, there has been a threefold increase in AV repairs (1) partly because of favourable results published in adults with low reintervention rates and long-term valverelated complications (1,3). In recent published cohorts, the freedom from AV reintervention following pediatric valve repairs ranged between 50% and 80% at 10 years, with a five-year median time to reoperation (1).…”

The normal aortic valve leaflets effective height in pediatric patients: A guide to aortic valve repair

“…In the past decade, favorable results in the adult patients and the emergence of a systematic approach to the AV partly explain the 3-fold increase in pediatric AV repairs. 1 The effective height (eH) is defined as the difference between the central free margins and the atrioventricular junction and is used as predictor of valve repair durability in adult patients. 2 , 3 Indeed, a postoperative eH <9 mm was associated with a higher risk of AV reintervention in the long-term.…”

Commentary: Toward a biologic understanding of autograft dilatation in the Ross procedure—creating opportunities to rescue the neoaortic root

“…In addition, further descriptive studies such as the important work by this talented group from Verona could lead to a truly mechanistic understanding of the cellular processes that determine autograft dilation, akin to the molecular breakthroughs in aortic dilation associated with Marfan syndrome. 10,11 As our understanding of the molecular landscape of the dilated autograft evolves, multiple important questions arise. Are the observed proteomic signatures the cause or the consequence of the failing neoaortic root?…”

“…Are there molecular targets for drug therapy in this setting as in the evolving medical approaches to aortic dilation in Marfan syndrome? 10,11 Could the vulnerable autograft be protected from dilation during the years of somatic growth with targeted medical therapy?…”

“…Their seminal work in the characterization of the proteomic signature for the failing autograft could ultimately lead to an enhanced recognition of the molecular pathophysiology, proteomic predictors, and therapeutic targets in this setting as part of the intense team effort to optimize the Ross procedure for our patients. 1,[7][8][9][10][11]…”