Mid and Long-Term Results after Aortic Valve Repair in Children and Adolescents

Objectives: Aortic valve repair for aortic regurgitation is an alternative to replacement in children and adolescents. There is limited data on long-term results of aortic valve repair in these patients. We analyzed our aortic valve repairs in children in order to clarify durability.

Methods: From 1997 to 2017, 98 patients 18 years of age or younger underwent aortic valve repair (mean age, 11.4 ± 5.2 years). Tricuspid aortic valve (TAV) was present in n = 20 (20.4%) bicuspid (BAV) in 17 (17.3%) and unicuspid (UAV) in 61 (62.2%). Isolated aortic valve repair was performed in 80 instances (81.6%). In the presence of aortic root dilatation additional root remodeling was performed (n = 18; 18.4%). Follow-up was complete in 91 patients (92.9%, mean: 95 ± 60 months; maximum: 251, minimum: 1).

Results: A 15-year survival was 96.6%. Freedom from reoperation after 5 years was 82.3 and 52.1% after 15 years. Repair durability was similar in BAV and TAV morphology after 10 years (91.7%/84%) but significant inferior in UAV (44.7%; p < 0.001). After root remodeling (BAV = 5, TAV = 12, UAV = 1) durability at 5 and 10 years was better than isolated valve repair (100 vs. 78.6%; 88.9 vs. 56.7%). Only one patient with remodeling (TAV) required reoperation after 65 months due to progressive regurgitation.

Conclusion: Durability of aortic valve repair in children and adolescents depends on valve morphology. Long-term results are good to excellent in BAV and TAV; after UAV repair relevant degeneration occurs.

No conflict of interest has been declared by the author(s).