Is Ross operation in neonates and infants justified? Aortic valve repair may postpone Ross operation

Quadricuspid aortic valve (QAV) is a rare congenital anomaly often associated with aortic insufficiency. The exact anatomy of QAV is variable, and most cases have undergone aortic valve replacement. With the recognition that aortic valve repair achieves superior patient outcomes as compared to replacement, a systematic approach to autologous reconstruction of QAV is needed. This article reports 2 cases having successful repair utilizing geometric aortic annuloplasty rings, and describes a proposed scheme for repairing most QAV defects, based on relative leaflet and commissural characteristics. Using either tri-leaflet or bicuspid ring annuloplasty, the normal sub-commissural triangles can be remodeled into a 120° or 180° configuration, respectively, and then the leaflets can be sutured and plicated to fit annular geometry. With this approach, most quadricuspid valves potentially could undergo autologous reconstruction.

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Commentary: Aortic Valve Repair In Children; Art Or Science?

JTCVS Techniques ◽

10.1016/j.xjtc.2021.06.027 ◽

2021 ◽

Author(s):

Bahaaldin Alsoufi

Keyword(s):

Aortic Valve ◽

Aortic Valve Repair ◽

Valve Repair

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Comparison of bicuspid and tricuspid aortic valve repair

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa462 ◽

2020 ◽

Author(s):

Radosław Gocoł ◽

Jarosław Bis ◽

Marcin Malinowski ◽

Joanna Ciosek ◽

Damian Hudziak ◽

...

Keyword(s):

Aortic Valve ◽

Hazard Ratio ◽

Aortic Valve Repair ◽

Pericardial Patch ◽

Valve Regurgitation ◽

Aortic Valve Regurgitation ◽

Valve Repair ◽

Tricuspid Aortic Valve ◽

Valve Annulus ◽

Annulus Diameter

Abstract OBJECTIVES The aim of this study was to compare the outcomes of tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV) repair. METHODS We assessed mortality, freedom from reoperation and the rate of aortic valve regurgitation recurrence. Mortality in both groups was compared with expected survival, and risk factors for reoperation were identified. RESULTS From January 2010 to April 2020, a total of 368 elective aortic valve repair procedures were performed, including 223 (60.6%) in patients with TAV. The perioperative mortality was 0.7% in the BAV group and 3.6% in the TAV group (P = 0.079). Estimated survival at 5 years in the BAV versus TAV group was 97 ± 3% vs 80 ± 6%, respectively (P < 0.001). Freedom from reoperation at 5 years in the TAV versus BAV group was 96 ± 3% vs 93 ± 4%, respectively (P = 0.28). Grade 2 or more aortic valve regurgitation was noted in 9.9% of BAV patients and 11% of TAV patients (P = 0.66). Reoperation was predicted by cusp perforation [hazard ratio 15.86 (4.44–56.61); P < 0.001], the use of pericardial patch [hazard ratio 8.58 (1.96–37.53); P = 0.004] and aortic valve annulus diameter >27.5 mm [hazard ratio 3.07 (0.99–9.58); P = 0.053]. CONCLUSIONS BAV repair is as durable as TAV repair. BAV is not a predictor of a higher rate of reoperations. BAV repair yields survival comparable to expected. Cusp perforation, aortic valve annulus diameter >27.5 mm and the use of pericardial patch adversely impact long-term outcome of aortic valve repair.

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