Outcomes of aortic valve repair in children stratified by complexity: Which outcome for which lesion?

OBJECTIVE Aortic valvuloplasty frequency has significantly increased over the past 15 years. Surgical repair varies in complexity depending on valvular lesions. The aim is to report results on the whole spectrum of aortic valvuloplasty techniques. METHODS All children who consecutively underwent aortic valvuloplasty for aortic stenosis and/or aortic insufficiency between January 2006 and December 2020 at Necker Sick Children’s Hospital (Paris, France) were included in a retrospective cohort study. Aortic valvuloplasty techniques were classified into 3 difficulty levels: (1) simple repair corresponding to commissurotomy and/or shaving in aortic stenosis (AS) in neonates (group 1) and children > 1 month (group 2); (2) intermediate complexity repair corresponding commissuroplasty, leaflet resuspension, fenestration closure in aortic insufficiency (leaflet prolapse in connective tissue disease, isolated leaflet prolapse and Laubry-Pezzi groups); and (3) complex repair requiring pericardial patch to restore a functional aortic valve in mixed aortic valve disease. (bicuspidization with neo-commissure and cusp extension groups). RESULTS During the study period, 324 children underwent aortic valvuloplasty. Survival and freedom from aortic valve reintervention at 10 years were respectively 86.1% and 50.9% in AS neonates, 95.2% and 71.7% in AS in children > 1 month, 93.8% and 79.5% in leaflet prolapse in connective tissue disease, 97.7% and 91.9% in isolated leaflet prolapse, 100% and 88% in Laubry-Pezzi syndrome, 97.4% and 84.8% in bicuspidization with neo-commissure and 100% and 54.2% in the cusp extension. CONCLUSION Durability of aortic valvuloplasty techniques is satisfactory and offers the possibility to delay the Ross procedure, regardless of the lesions complexity. Aortic valvuloplasty frequency has significantly increased over the past 15 years. Surgical repair varies in complexity depending on valvular lesions. The aim is to report results on the whole spectrum of aortic valvuloplasty techniques. All children who consecutively underwent aortic valvuloplasty for aortic stenosis and/or aortic insufficiency between January 2006 and December 2020 at Necker Sick Children’s Hospital (Paris, France) were included in a retrospective cohort study. Aortic valvuloplasty techniques were classified into 3 difficulty levels: (1) simple repair corresponding to commissurotomy and/or shaving in aortic stenosis (AS) in neonates (group 1) and children > 1 month (group 2); (2) intermediate complexity repair corresponding commissuroplasty, leaflet resuspension, fenestration closure in aortic insufficiency (leaflet prolapse in connective tissue disease, isolated leaflet prolapse and Laubry-Pezzi groups); and (3) complex repair requiring pericardial patch to restore a functional aortic valve in mixed aortic valve disease. (bicuspidization with neo-commissure and cusp extension groups). During the study period, 324 children underwent aortic valvuloplasty. Survival and freedom from aortic valve reintervention at 10 years were respectively 86.1% and 50.9% in AS neonates, 95.2% and 71.7% in AS in children > 1 month, 93.8% and 79.5% in leaflet prolapse in connective tissue disease, 97.7% and 91.9% in isolated leaflet prolapse, 100% and 88% in Laubry-Pezzi syndrome, 97.4% and 84.8% in bicuspidization with neo-commissure and 100% and 54.2% in the cusp extension. Durability of aortic valvuloplasty techniques is satisfactory and offers the possibility to delay the Ross procedure, regardless of the lesions complexity.