Ross procedure or complex aortic valve repair using pericardium in children: A real dilemma

Pichoy Danial; Asma Neily; Margaux Pontailler; Régis Gaudin; Diala Khraiche; Mary Osborne-Pellegrin; Pascal Vouhe; Olivier Raisky

doi:10.1016/j.jtcvs.2021.02.093

Ross procedure or complex aortic valve repair using pericardium in children: A real dilemma

J Thorac Cardiovasc Surg. 2022 Mar;163(3):1180-1191.e6. doi: 10.1016/j.jtcvs.2021.02.093. Epub 2021 Mar 10.

Authors

Pichoy Danial¹, Asma Neily², Margaux Pontailler², Régis Gaudin², Diala Khraiche², Mary Osborne-Pellegrin³, Pascal Vouhe², Olivier Raisky⁴

Affiliations

¹ Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France; Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France.
² Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France.
³ Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France.
⁴ Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France. Electronic address: oraisky@yahoo.com.

PMID: 33820635
DOI: 10.1016/j.jtcvs.2021.02.093

Abstract

Objective: Difficult to repair aortic valve lesions, requiring the use of a valve substitute, remain controversial in the face of the Ross procedure, despite undeniable technical advances. This study was undertaken to compare midterm outcomes of children treated using the Ross procedure or aortic valvuloplasty for complex aortic valve lesions.

Methods: Between January 2006 and December 2017, 126 patients aged younger than 18 years were treated for complex aortic stenosis and/or aortic insufficiency and were included in this retrospective study. Only aortic valve lesions requiring repair with an autologous or heterologous pericardial patch were considered complex lesions. Propensity score framework analyses were used to compare outcomes of the Ross and aortic valvuloplasty groups while controlling for confounders.

Results: Among the 126 patients with complex aortic valve lesions, propensity score matching selected 34 unique pairs of patients with similar characteristics. Survival (aortic valvuloplasty, 94.1%; Ross, 91%; P = .89), freedom from overall reintervention (aortic valvuloplasty, 50.1%; Ross, 69%; P = .32), and freedom from infective endocarditis at 8 years (aortic valvuloplasty, 100%; Ross, 85.9%; P = .21) were similar. However, freedom from reintervention in the left ventricular outflow tract at 8 years was lower after aortic valvuloplasty than after the Ross procedure (50.1% vs 100%, respectively; P = .001).

Conclusions: Aortic valvuloplasty and the Ross procedure yielded similar 8-year outcomes regarding death, reoperation, and infective endocarditis although aortic valvuloplasty tended to be associated with fewer cases of infective endocarditis. Aortic valvuloplasty using a pericardial patch can be chosen as a first-line strategy for treating complex aortic valve lesions and might offer the possibility of a later Ross procedure.

Keywords: Ross procedure; aortic valvuloplasty; complex aortic valve disease.

Publication types

Comparative Study
Observational Study

MeSH terms

Adolescent
Age Factors
Aortic Valve Insufficiency / diagnostic imaging
Aortic Valve Insufficiency / physiopathology
Aortic Valve Insufficiency / surgery*
Aortic Valve Stenosis / diagnostic imaging
Aortic Valve Stenosis / physiopathology
Aortic Valve Stenosis / surgery*
Cardiac Surgical Procedures* / adverse effects
Child
Child, Preschool
Clinical Decision-Making
Female
Heart Valve Prosthesis Implantation* / adverse effects
Humans
Infant
Infant, Newborn
Male
Pericardium / transplantation*
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome