Selective tricuspidization and aortic cusp extension valvuloplasty

Outcome analysis in infants and children

Anastasios C. Polimenakos, Shyam Sathanandam, Christopher Blair, Chawki Elzein, David Roberson, Michel N. Ilbawi

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Encouraging early outcomes of emerging aortic cusp extension valvuloplasty techniques have redirected attention to nonreplacement strategies in the management of younger patients with aortic insufficiency or aortic stenosis. Outcome analysis after aortic cusp extension valvuloplasty in infants and children was undertaken. Methods: From July 1987 to December 2008, 78 patients younger than 10 years of age underwent aortic cusp extension valvuloplasty in the form of pericardial cusp extension and selective use of tricuspidization. Sixteen (20.5%) patients were younger than 1 year of age. Twenty-seven had bicuspid aortic valve, 34, congenital aortic valve stenosis, and 17, congenital or acquired aortic insufficiency or aortic stenosis. Forty-two patients had balloon valvuloplasty or surgical valvotomy before aortic cusp extension valvuloplasty. Median follow-up was 12.4 years (range, 0.1 to 21.6 years). Freedom from aortic valve replacement (AVR) and determinants of outcome were analyzed. Results: There were no early or late deaths. During the follow-up period, 23 patients (29.5%) had Ross operation and 8 patients (10.2%) had other AVR. The z values of left ventricular end-diastolic dimension, aortic annulus, aortic sinus diameter, sinotubular junction diameter, and left ventricular wall thickness before AVR were 3.8 ± 2.95, 2.1 ± 1.15, 4.2 ± 1.22, 1.78 ± 1.24, and 2.92 ± 1.31, respectively. Actuarial freedom from AVR at 1, 5, and 10 years was 97.3 ± 2.0%, 71.3 ± 5.8%, and 55.6 ± 6.9%, respectively. Conclusions: Aortic cusp extension valvuloplasty with tricuspidization allows left ventricular reverse remodeling with satisfactory long-term durability and freedom from AVR. Used selectively, it represents a reliable and effective approach in infants and children with congenital or acquired abnormal aortic valve.

Original languageEnglish (US)
Pages (from-to)839-847
Number of pages9
JournalAnnals of Thoracic Surgery
Volume90
Issue number3
DOIs
StatePublished - Jan 1 2010
Externally publishedYes

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Aortic Valve
Aortic Valve Stenosis
Balloon Valvuloplasty
Sinus of Valsalva
Ventricular Remodeling

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Selective tricuspidization and aortic cusp extension valvuloplasty : Outcome analysis in infants and children. / Polimenakos, Anastasios C.; Sathanandam, Shyam; Blair, Christopher; Elzein, Chawki; Roberson, David; Ilbawi, Michel N.

In: Annals of Thoracic Surgery, Vol. 90, No. 3, 01.01.2010, p. 839-847.

Research output: Contribution to journalArticle

Polimenakos, Anastasios C. ; Sathanandam, Shyam ; Blair, Christopher ; Elzein, Chawki ; Roberson, David ; Ilbawi, Michel N. / Selective tricuspidization and aortic cusp extension valvuloplasty : Outcome analysis in infants and children. In: Annals of Thoracic Surgery. 2010 ; Vol. 90, No. 3. pp. 839-847.
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abstract = "Background: Encouraging early outcomes of emerging aortic cusp extension valvuloplasty techniques have redirected attention to nonreplacement strategies in the management of younger patients with aortic insufficiency or aortic stenosis. Outcome analysis after aortic cusp extension valvuloplasty in infants and children was undertaken. Methods: From July 1987 to December 2008, 78 patients younger than 10 years of age underwent aortic cusp extension valvuloplasty in the form of pericardial cusp extension and selective use of tricuspidization. Sixteen (20.5{\%}) patients were younger than 1 year of age. Twenty-seven had bicuspid aortic valve, 34, congenital aortic valve stenosis, and 17, congenital or acquired aortic insufficiency or aortic stenosis. Forty-two patients had balloon valvuloplasty or surgical valvotomy before aortic cusp extension valvuloplasty. Median follow-up was 12.4 years (range, 0.1 to 21.6 years). Freedom from aortic valve replacement (AVR) and determinants of outcome were analyzed. Results: There were no early or late deaths. During the follow-up period, 23 patients (29.5{\%}) had Ross operation and 8 patients (10.2{\%}) had other AVR. The z values of left ventricular end-diastolic dimension, aortic annulus, aortic sinus diameter, sinotubular junction diameter, and left ventricular wall thickness before AVR were 3.8 ± 2.95, 2.1 ± 1.15, 4.2 ± 1.22, 1.78 ± 1.24, and 2.92 ± 1.31, respectively. Actuarial freedom from AVR at 1, 5, and 10 years was 97.3 ± 2.0{\%}, 71.3 ± 5.8{\%}, and 55.6 ± 6.9{\%}, respectively. Conclusions: Aortic cusp extension valvuloplasty with tricuspidization allows left ventricular reverse remodeling with satisfactory long-term durability and freedom from AVR. Used selectively, it represents a reliable and effective approach in infants and children with congenital or acquired abnormal aortic valve.",
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AU - Polimenakos, Anastasios C.

AU - Sathanandam, Shyam

AU - Blair, Christopher

AU - Elzein, Chawki

AU - Roberson, David

AU - Ilbawi, Michel N.

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AB - Background: Encouraging early outcomes of emerging aortic cusp extension valvuloplasty techniques have redirected attention to nonreplacement strategies in the management of younger patients with aortic insufficiency or aortic stenosis. Outcome analysis after aortic cusp extension valvuloplasty in infants and children was undertaken. Methods: From July 1987 to December 2008, 78 patients younger than 10 years of age underwent aortic cusp extension valvuloplasty in the form of pericardial cusp extension and selective use of tricuspidization. Sixteen (20.5%) patients were younger than 1 year of age. Twenty-seven had bicuspid aortic valve, 34, congenital aortic valve stenosis, and 17, congenital or acquired aortic insufficiency or aortic stenosis. Forty-two patients had balloon valvuloplasty or surgical valvotomy before aortic cusp extension valvuloplasty. Median follow-up was 12.4 years (range, 0.1 to 21.6 years). Freedom from aortic valve replacement (AVR) and determinants of outcome were analyzed. Results: There were no early or late deaths. During the follow-up period, 23 patients (29.5%) had Ross operation and 8 patients (10.2%) had other AVR. The z values of left ventricular end-diastolic dimension, aortic annulus, aortic sinus diameter, sinotubular junction diameter, and left ventricular wall thickness before AVR were 3.8 ± 2.95, 2.1 ± 1.15, 4.2 ± 1.22, 1.78 ± 1.24, and 2.92 ± 1.31, respectively. Actuarial freedom from AVR at 1, 5, and 10 years was 97.3 ± 2.0%, 71.3 ± 5.8%, and 55.6 ± 6.9%, respectively. Conclusions: Aortic cusp extension valvuloplasty with tricuspidization allows left ventricular reverse remodeling with satisfactory long-term durability and freedom from AVR. Used selectively, it represents a reliable and effective approach in infants and children with congenital or acquired abnormal aortic valve.

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