Commentary: Aortic valve surgery in children: Repair now, Ross procedure later

Buratto, Edward; Konstantinov, Igor E.

doi:10.1016/j.jtcvs.2021.03.064

Cited by 8 publications

(4 citation statements)

References 10 publications

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“…Postponing a Ross at a young age may therefore be sensible if the valve is amenable to repair. 93 , 94 Improvements in repair techniques to achieve a durable result may thus be of benefit to children with AVD. 89 , 95–97 …”

Section: Discussionmentioning

confidence: 99%

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Paediatric aortic valve replacement: a meta-analysis and microsimulation study

Notenboom

Schuermans

Etnel

et al. 2023

European Heart Journal

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Aims To support decision-making in children undergoing aortic valve replacement (AVR), by providing a comprehensive overview of published outcomes after paediatric AVR, and microsimulation-based age-specific estimates of outcome with different valve substitutes. Methods and results A systematic review of published literature reporting clinical outcome after paediatric AVR (mean age <18 years) published between 1/1/1990 and 11/08/2021 was conducted. Publications reporting outcome after paediatric Ross procedure, mechanical AVR (mAVR), homograft AVR (hAVR), and/or bioprosthetic AVR were considered for inclusion. Early risks (<30d), late event rates (>30d) and time-to-event data were pooled and entered into a microsimulation model. Sixty-eight studies, of which one prospective and 67 retrospective cohort studies, were included, encompassing a total of 5259 patients (37 435 patient-years; median follow-up: 5.9 years; range 1–21 years). Pooled mean age for the Ross procedure, mAVR, and hAVR was 9.2 ± 5.6, 13.0 ± 3.4, and 8.4 ± 5.4 years, respectively. Pooled early mortality for the Ross procedure, mAVR, and hAVR was 3.7% (95% CI, 3.0%–4.7%), 7.0% (5.1%–9.6%), and 10.6% (6.6%–17.0%), respectively, and late mortality rate was 0.5%/year (0.4%–0.7%/year), 1.0%/year (0.6%–1.5%/year), and 1.4%/year (0.8%–2.5%/year), respectively. Microsimulation-based mean life-expectancy in the first 20 years was 18.9 years (18.6–19.1 years) after Ross (relative life-expectancy: 94.8%) and 17.0 years (16.5–17.6 years) after mAVR (relative life-expectancy: 86.3%). Microsimulation-based 20-year risk of aortic valve reintervention was 42.0% (95% CI: 39.6%–44.6%) after Ross and 17.8% (95% CI: 17.0%–19.4%) after mAVR. Conclusion Results of paediatric AVR are currently suboptimal with substantial mortality especially in the very young with considerable reintervention hazards for all valve substitutes, but the Ross procedure provides a survival benefit over mAVR. Pros and cons of substitutes should be carefully weighed during paediatric valve selection.

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Section: Discussionmentioning

confidence: 99%

“…Further modifications on the autograft, 98 improvements in AV repair 93 , 95 and other innovative therapies such as tissue-engineered valves 99 , 100 deserve attention in the future to further improve clinical and patient-reported outcome after paediatric AV surgery, not merely during childhood but beyond as well.…”

Section: Discussionmentioning

confidence: 99%

Paediatric aortic valve replacement: a meta-analysis and microsimulation study

Notenboom

Schuermans

Etnel

et al. 2023

European Heart Journal

View full text Add to dashboard Cite

show abstract

“…Furthermore, efforts to increase durability of repair seem to be becoming crucial in decision-making in pediatric and adolescent patients following the modern concept of a staged approach to UAV with repair as the first. [11][12][13] We read with great interest the recent paper on the congenital UAV repair by Dr. El-Khoury. 14 The technique presented in a recent JOCS issue proposes repair without a patch but based on the mobilization and preservation of as much own tissue as possible.…”

mentioning

confidence: 99%

“…Furthermore, efforts to increase durability of repair seem to be becoming crucial in decision‐making in pediatric and adolescent patients following the modern concept of a staged approach to UAV with repair as the first 11–13 …”

mentioning

confidence: 99%