PMID- 32061889 OWN - NLM STAT- MEDLINE DCOM- 20201020 LR - 20210110 IS - 1532-9488 (Electronic) IS - 1043-0679 (Linking) VI - 32 IP - 3 DP - 2020 Autumn TI - Strategies to Minimise Need for Prosthetic Aortic Valve Replacement in Congenital Aortic Stenosis-Value of the Ross Procedure. PG - 509-519 LID - S1043-0679(20)30030-7 [pii] LID - 10.1053/j.semtcvs.2020.02.015 [doi] AB - To examine the role and outcomes of all interventions for aortic stenosis in children, with focus on freedom from reintervention and the aim to minimise prosthetic aortic valve replacement (pAVR) during childhood. Retrospective analysis of 194 consecutive children who underwent any aortic valve intervention for a biventricular repair strategy at a single institution between 1995 and 2017. Data were obtained from hospital records and follow-up was 100% complete. Over a 22-year period, 194 children underwent total 313 aortic valve procedures: Primary interventions were surgical valvotomy (SV)/surgical repair (SR) in 94 (48.5%), balloon valvuloplasty (BV) in 60 (30.9%), pAVR in 8 (4.1%) and Ross/Ross-Konno procedure in 32 (16.5%). Median age at first intervention was 1.1 years (interquartile range [IQR] 0.1-9.4) and varied with type of intervention: SV/SR were most common in neonates (33, 75%) and infants (35, 68%), whilst BV was most frequent in older children (42, 42%). Operative survival was 99% (2 early deaths, both in neonates with critical aortic stenosis and poor left ventricular function) and 15-year survival was 95%. A Ross procedure was performed in 79 (40.7%) patients over the 15-year study period, 1 of whom required late pAVR for autograft failure. Freedom from any reintervention after SV/SR and BV was 41% and 40% at 10 years, compared to 90% at 10 years with the Ross procedure (P < 0.001). Among neonatal SV/SR and BV, 98% required reintervention during childhood with no difference between groups. Valve morphology did not influence freedom from ultimate valve replacement. In patients who went on to have a Ross procedure, median time from initial intervention to Ross was 2.8 years (IQR 0.1-11.9) in neonates and 6.0 years (IQR 3.1-7.5) in all other age groups. Overall freedom from pAVR was 97% at 10 years and was similar in the SV/SR and BV groups. A strategy of simple valve repair and primary Ross procedure provides excellent survival and good freedom from pAVR. However, reintervention rates after simple interventions for congenital AS are high, especially in younger age groups. The Ross procedure offers the best freedom from reintervention of any technique and wider use of primary Ross in younger age groups should be considered. CI - Copyright (c) 2020 Elsevier Inc. All rights reserved. FAU - Ivanov, Yaroslav AU - Ivanov Y AD - Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom. Electronic address: iyaroslav@ukr.net. FAU - Drury, Nigel E AU - Drury NE AD - Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom. FAU - Stickley, John AU - Stickley J AD - Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom. FAU - Botha, Phil AU - Botha P AD - Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom. FAU - Khan, Natasha E AU - Khan NE AD - Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom. FAU - Jones, Timothy J AU - Jones TJ AD - Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom. FAU - Brawn, William J AU - Brawn WJ AD - Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom. FAU - Barron, David J AU - Barron DJ AD - Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom. LA - eng GR - FS/15/49/31612/BHF_/British Heart Foundation/United Kingdom PT - Comparative Study PT - Journal Article PT - Observational Study DEP - 20200213 PL - United States TA - Semin Thorac Cardiovasc Surg JT - Seminars in thoracic and cardiovascular surgery JID - 8917640 SB - IM CIN - Semin Thorac Cardiovasc Surg. 2020 Autumn;32(3):520-521. PMID: 32371173 MH - Adolescent MH - Aortic Valve/abnormalities/diagnostic imaging/physiopathology/*surgery MH - Aortic Valve Stenosis/congenital/diagnostic imaging/physiopathology/*surgery MH - *Balloon Valvuloplasty/adverse effects MH - Child MH - Child, Preschool MH - Female MH - Heart Defects, Congenital/diagnostic imaging/physiopathology/*surgery MH - Heart Valve Prosthesis MH - *Heart Valve Prosthesis Implantation/adverse effects/instrumentation MH - Humans MH - Infant MH - Infant, Newborn MH - Male MH - Postoperative Complications/surgery MH - Recovery of Function MH - Reoperation MH - Retrospective Studies MH - Risk Factors MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - Congenital aortic stenosis OT - Prosthetic aortic valve replacement OT - Ross procedure EDAT- 2020/02/18 06:00 MHDA- 2020/10/21 06:00 CRDT- 2020/02/17 06:00 PHST- 2020/02/06 00:00 [received] PHST- 2020/02/10 00:00 [accepted] PHST- 2020/02/18 06:00 [pubmed] PHST- 2020/10/21 06:00 [medline] PHST- 2020/02/17 06:00 [entrez] AID - S1043-0679(20)30030-7 [pii] AID - 10.1053/j.semtcvs.2020.02.015 [doi] PST - ppublish SO - Semin Thorac Cardiovasc Surg. 2020 Autumn;32(3):509-519. doi: 10.1053/j.semtcvs.2020.02.015. Epub 2020 Feb 13.