Neoartic valve insufficiency assessment after pulmonary autograft implantation in pediatric patients during long term follow-up

  • O. N. Romanyuk Government institution «The Scientific-Practical Children`s Cardiac Center the Ministry of Health of Ukraine», Kyiv, Ukraine; Shupyk National Medical Academy of Postgraduate Education, Kyiv
  • Y. I. Klymyshyn Government institution «The Scientific-Practical Children`s Cardiac Center the Ministry of Health of Ukraine», Kyiv, Ukraine
  • E. A. Artemenko Government institution «The Scientific-Practical Children`s Cardiac Center the Ministry of Health of Ukraine», Kyiv, Ukraine; Shupyk National Medical Academy of Postgraduate Education, Kyiv
  • D. O. Dzyurman Government institution «The Scientific-Practical Children`s Cardiac Center the Ministry of Health of Ukraine», Kyiv, Ukraine
  • N. N. Rudenko Government institution «The Scientific-Practical Children`s Cardiac Center the Ministry of Health of Ukraine», Kyiv, Ukraine; Shupyk National Medical Academy of Postgraduate Education, Kyiv
Keywords: pulmonary autograft, aortic valve, aortic root, neoaortic valve insufficiency

Abstract

An alternative method of aortic valve surgical treatment in children of different age groups is pulmonary au-tograft implantation. After detailed study of operational results we identified predictors of neoaortic valve insufficiency and neoaortic root dilatation in a remote postoperative period.

Purpose: tо analyze autograft dysfunction causes in postoperative period and to evaluate the influence of root reinforce-ment techniques on neoaortic valve insufficiency and neoaortic root dilatation development in long term period.

Materials and methods. 151 consecutive patients <18 years age group, which undergone pulmonary autograft implanta-tion in period between 1996 and 2014.

Results. Neoaortic root enlargement over age norms during 15-year observation period occurred at all three levels. Basal ring diameter (BR) changed from 1,32±1,1 (-2; 5,3) units in the early postoperative period to 3,2±1,3 (0,3; 5,4) in a remote period, sinuses Valsalva (SV) - from 1,63±1,2 (-1,6; 4,4) to 4,2±1,7 (0,5; 8,8), sinotubular junction (STJ) – from 1,8±1,1 (-1; 5,6) to 4,6±2,2 (0,8; 10,6) (p=0.001). BR dilatation in the remote period was observed in 46,3% (n=70) patients, SV dilation – in 67,7% (n=23) and STJ – in 58,8% (n=89) of patients.

Conclusions. Neoaortic root dilatation and neoaortic valve insufficiency development is the most common cause of autograft dysfunction and is typical for the late period in patients after pulmonary autograft implantation. Application of autograft root reinforcement concept strengthening at two levels significantly reduced the degree of neoartic root dilatation and neoaortic valve insufficiency incidence in our study.

References

1. Ross D. N. Replacement of aortic and mitral valves with a pulmonary autograft / Ross D.N. // Lancet. – 1967. – Vol. 2. – P. 956–958.

2. The Ross procedure in patients aged less than 18 years: The midterm results / Gianluca Brancaccio, MD, Angelo Polito, MD, Stiljan Hoxha, MD, et al. // The Journal of Thoracic and Cardiovascular Surgery. – 2014. – Vol. 147. – P. 383–388.

3. Sievers H-H. A multicentre evaluation of the autograft procedure for young patients undergoing aortic valve replacement: update on the German Ross Registry / Sievers H-H., Stierle U., Charitos E. I. et al. // Eur J Cardiothorac Surg. – 2015. – Vol. 5. – P. 98.

4. Klieverik L. M. The Ross operation: a Trojan horse? / Klieverik L. M., Takkenberg J. J., Bekkers J. A. et al. // Eur Heart J. – 2007. – Vol. 28. – P. 1993–2000.

5. Pasquali S. K. The relationship between neo-aortic dilatation, insufficiency and reintervention following the Ross procedure in infants, children and young adults / Pasquali S. K., Cohen M. S., Shera D. et al. // J Am Coll Cardiol. – 2007. – Vol. 49. – P. 25–32.

6. Ruzmetov M. Failed Autograft After the Ross Procedure in Children: Management and Outcome / Ruzmetov M., Welke K. F., Geiss D. M. et al. // Ann Thorac Surg. – 2014. – Vol. 98 (1). – P. 112–118.

7. Frigiola А. Neoaortic Valve and Root Complex Evolution After Ross Operation in Infants, Children, and Adolescents / Frigiola А., Varrica А., Satriano А. et al. // Ann Thorac Surg. – 2010. – Vol. 90. – P. 1278–1286.

8. Age-Related Outcomes of the Ross Procedure Over 20 Years / Bansal N., Kumar S. R., Baker C. J. et al. // Ann Thorac Surg. – 2015. – Vol. 99. – P. 77–83.

9. Kalfa D. Long-term outcomes of the Ross procedure in adults with severe aortic stenosis: single-centre experience with 20 years of follow-up / Kalfa D., Mohammadi S., Kalavrouziotis D., et al. // Eur J Cardiothorac Surg. – 2015. – Vol. 47. – P. 159–167.
Published
2017-05-15
How to Cite
Romanyuk, O. N., Klymyshyn, Y. I., Artemenko, E. A., Dzyurman, D. O., & Rudenko, N. N. (2017). Neoartic valve insufficiency assessment after pulmonary autograft implantation in pediatric patients during long term follow-up. Ukrainian Journal of Cardiovascular Surgery, (1 (27), 84-89. Retrieved from http://cvs.org.ua/index.php/ujcvs/article/view/184
Section
CONGENITAL HEART DEFECTS