Abstract
Congenital pathology of the aortic valve in young children is mainly represented by its stenotic lesion. The incidence of valvular aortic stenosis in children is 3–6% of all congenital heart defects. Options for surgical treatment of aortic valve pathology in children are limited and have questionable long-term effectiveness. The promising results of Ozaki procedure in adults led to its introduction into pediatric cardiac surgery. However, the experience of its implementation in pediatric practice, in particular in young children, is quite limited. The aim of this work is to present own experience, discuss the main results of the operation in world and domestic practice. The problem of choosing a correction method in childhood is touched upon, and the auxiliary role of new technologies, in particular 3D printing, at the stage of surgery planning is also noted.
References
- Chernogrivov A.E., Chernogrivov I.E., Bofanov D.A., Bazylev V.V. Ozaki procedure in children: a single-center study of mid-term outcomes. Children’s Heart and Vascular Diseases. 2021; 18 (2): 129–140 (in Russ.). DOI: 10.24022/1810-0686-2021-18-2-129-140
- Baryshnikova I.Yu., Shakhnazaryan E.A., Chernogrivov A.E., Nefedova I.E. Hemodynamic justification of the use of the autopericardium in reconstructive surgery of the aortic valve in infants. Children’s Heart and Vascular Diseases. 2023; 20 (2): 148–153 (in Russ.). DOI:
10.24022/1810-0686-2023-20-2-148-153
- Bazylev V.V., Chernogrivov I.E., Gamzaev A.B., Bofanov D.A., Nazarova I.S., Ryabova A.O., Chernogrivov A.E. Reconstructive interventions on the aortic valve and Ross surgery in heart valve surgery in children. Children’s Heart and Vascular Diseases. 2020; 17 (3): 205–213 (in Russ.). DOI: 10.24022/1810-0686-2020-17-3-205-213
- Ozaki S., Kawase I., Yamashita H., Uchida S., Nozawa Y., Matsuyama T. et al. Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease. Interact. Cardiovasc. Thorac. Surg. 2011; 12 (4): 550–553. DOI: 10.1510/icvts.2010.253682
- Michelena H.I. et al.; Endorsed by the Heart Valve Society (HVS), European Association of Cardiovascular Imaging (EACVI), Society of
Thoracic Surgeons (STS), American Association for Thoracic Surgery (AATS), Society for Cardiovascular Magnetic Resonance (SCMR),
Society of Cardiovascular Computed Tomography (SCCT), North American Society for Cardiovascular Imaging (NASCI) and the International
Bicuspid Aortic Valve Consortium (BAVCon). International consensus statement on nomenclature and classification of the congenital bicuspid
aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. Eur. J. Cardiothorac. Surg. 2021; 60 (3): 448–476.
DOI: 10.1093/ejcts/ezab038
- Ozaki S., Kawase I., Yamashita H., Uchida S., Nozawa Y., Takatoh M., Hagiwara S. A total of 404 cases of aortic valve reconstruction with glutaraldehyde-treated autologous pericardium. J. Thorac. Cardiovasc. Surg. 2014; 147 (1): 301–306. DOI: 10.1016/j.jtcvs.2012.11.012
- Baird C.W., Sefton B., Chávez M., Sleeper L.A., Marx G.R., del Nido P.J. Congenital aortic and truncal valve reconstruction utilizing the Ozaki technique: short-term clinical results. J. Thorac. Cardiovasc. Surg. 2021; 161 (5): 1567–1577. DOI: 10.1016/j.jtcvs.2020.01.087
- Polito A., Albanese S.B., Cetrano E., Forcina S., Cicenia M., Rinelli G. et al. Aortic valve neocuspidalization may be a viable alternative to
Ross operation in pediatric patients. Pediatr. Cardiol. 2021; 42 (3): 668–675. DOI: 10.1007/s00246-020-02528-3
- Wiggins L.M., Mimic B., Issitt R., Ilic S., Bonello B., Marek J., Kostolny M. The utility of aortic valve leaflet reconstruction techniques in
children and young adults. J. Thorac. Cardiovasc. Surg. 2020; 159 (6): 2369–2378. DOI: 10.1016/j.jtcvs.2019.09.176
- Chivers S.C., Pavy C., Vaja R., Quarto C., Ghez O., Daubeney P.E.F. The Ozaki procedure with CardioCel patch for children and young adults with aortic valve disease: preliminary experience – a word of caution. World J. Pediatric. Congenit. Heart Surg. 2019; 10 (6): 724–730.
DOI:10.1177/2150135119878108
- Marathe S.P., Chávez M., Sleeper L.A., Marx G., Del Nido P.J., Baird C.W. Modified Ozaki procedure including annular enlargement for small aortic annuli in young patients. Ann. Thorac. Surg. 2020; 110 (4): 1364–1371. DOI: 10.1016/j.athoracsur.2020.04.025
- Secinaro A., Milano E.G., Ciancarella P., Trezzi M., Capelli C., Ciliberti P. et al. Blood flow characteristics after aortic valve neocuspidization in paediatric patients: a comparison with the Ross procedure. Eur. Heart J. Cardiovasc. Imag. 2022; 23 (2): 275–282. DOI: 10.1093/EHJCI/JEAB009
- Bazylev V.V., Chernogrivov A.E., Bofanov D.A., Babukov R.M., Gamzaev A.B., Nachkebia B.R. et al. Age dependence of results of the utility of aortic valve neo-tricuspidalization or Ozaki operation in children. Children’s Heart and Vascular Diseases. 2021; 18 (4): 184–198 (in Russ.). DOI: 10.24022/1810-0686-2021-18-3-184-198
- Akins C.W., Miller D.C., Turina M.I., Kouchoukos N.T., Blackstone E.H., Grunkemeier G.L. et al.; STS; AATS; EACTS. Guidelines for
reporting mortality and morbidity after cardiac valve interventions. Ann. Thorac. Surg. 2008; 85 (4): 1490–1495. DOI: 10.1016/j.athoracsur.2007.12.082
- Elkins R.C. The Ross operation: applications to children. Semin. Thorac. Cardiovasc. Surg. 1996; 8 (4): 345–349. PMID: 8899920.
- da Costa F.D., Pere
ira E.W., Barboza L.E., Haggi Filho H., Collatusso C., Gomes C.H. et al. Ten-year experience with the Ross operation. Arq.
Bras. Cardiol. 2006; 87 (5): 583–5891. DOI: 10.1590/s0066-782x2006001800006
- Elkins R.C., Thompson D.M., Lane M.M., Elkins C.C., Peyton M.D. Ross operation: 16-year experience. J. Thorac. Cardiovasc. Surg. 2008; 136 (3): 623–630, 630.e1-5. DOI: 10.1016/j.jtcvs.2008.02.080
- Takkenberg J.J., Kappetein A.P., van Herwerden L.A., Witsenburg M., Van Osch-Gevers L., Bogers A.J. Pediatric autograft aortic root
replacement: a prospective follow-up study. Ann. Thorac. Surg. 2005; 80 (5): 1628–16233. DOI: 10.1016/j.athoracsur.2005.04.057
- Mokhles M.M., Rizopoulos D., Andrinopoulou E.R., Bekkers J.A., Roos-Hesselink J.W., Lesaffre E. et al. Autograft and pulmonary allograft performance in the second post-operative decade after the Ross procedure: insights from the Rotterdam Prospective Cohort Study. Eur. Heart
J. 2012; 33 (17): 2213–2224. DOI: 10.1093/eurheartj/ehs173
- Brown J.W., Ruzmetov M., Vijay P., Rodefeld M.D., Turrentine M.W. Surgery for aortic stenosis in children: a 40-year experience. Ann. Thorac. Surg. 2003; 76 (5): 1398–1411. DOI: 10.1016/s0003-4975(03)01027-0
- Karamlou T., Jang K., Williams W.G., Caldarone C.A., Van Arsdell G., Coles J.G., McCrindle B.W. Outcomes and associated risk factors for aortic valve replacement in 160 children: a competing-risks analysis. Circulation. 2005; 112 (22): 3462–3469. DOI: 10.1161/ CIRCULATIONAHA.105.541649
- Turrentine M.W., Ruzmetov M., Vijay P., Bills R.G., Brown J.W. Biological versus mechanical aortic valve replacement in children. Ann. Thorac. Surg. 2001; 71 (5 Suppl): S356–360. DOI: 10.1016/s0003-4975 (01)02507-3
- Starnes V.A., Luciani G.B., Wells W.J., Allen R.B., Lewis A.B. Aortic root replacement with the pulmonary autograft in children with complex left heart obstruction. Ann. Thorac. Surg. 1996; 62 (2): 442448; discussion 448449.
- Elkins R.C., Lane M.M., McCue C. Ross operation in children: late results. J. Heart Valve Dis. 2001; 10 (6): 736–741. PMID: 11767179.
- van Hagen I.M., Roos-Hesselink J.W., Ruys T.P., Merz W.M., Goland S., Gabriel H. et al.; ROPAC Investigators and the EURObservational Research Programme (EORP) Team*. Pregnancy in Women With a Mechanical Heart Valve: Data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC). Circulation. 2015; 132 (2): 132–142. DOI: 10.1161/CIRCULATIONAHA.115.015242
- Takkenberg J.J., Klieverik L.M., Bekkers J.A., Kappetein A.P., Roos J.W., Eijkemans M.J., Bogers A.J. Allografts for aortic valve or root replacement: insights from an 18-year single-center prospective follow-up study. Eur. J. Cardiothorac. Surg. 2007; 31 (5): 851–859. DOI: 10.1016/j.ejcts.2007.02.009
- Ruzmetov M., Vijay P., Rodefeld M.D., Turrentine M.W., Brown J.W. Evolution of aortic valve replacement in children: a single center experience. Int. J. Cardiol. 2006; 113 (2): 194–200. DOI: 10.1016/j.ijcard.2005.11.011
- Ali A., Lim E., Halstead J., Ashrafian H., Ali Z., Khalpey Z. et al. Porcine or human stentless valves for aortic valve replacement? Results of a 10-year comparative study. J. Heart Valve Dis. 2003; 12 (4): 430–435; discussion 435.
- Schoen F.J., Levy R.J. Calcification of tissue heart valve substitutes: progress toward understanding and prevention. Ann. Thorac. Surg. 2005; 79 (3): 1072–1080. DOI: 10.1016/j.athoracsur.2004.06.033
- Duran C.M., Gometza B., Shahid M., Al-Halees Z. Treated bovine and autologous pericardium for aortic valve reconstruction. Ann. Thorac. Surg. 1998; 66 (6 Suppl): S166–169. DOI: 10.1016/s0003-4975(98)01030-3
- Al Halees Z., Al Shahid M., Al Sanei A., Sallehuddin A., Duran C. Up to 16 years follow-up of aortic valve reconstruction with pericardium: a stentless readily available cheap valve? Eur. J. Cardiothorac. Surg. 2005; 28 (2): 200–205; discussion 205. DOI: 10.1016/j.ejcts.2005.04.041
- Baird C.W., Myers P.O., Piekarski B., Borisuk M., Majeed A., Emani S.M. et al. Photo-oxidized bovine pericardium in congenital cardiac surgery: single-centre experience. Interact. Cardiovasc. Thorac. Surg. 2017; 24 (2): 240–244. DOI: 10.1093/icvts/ivw315
- Majeed A., Baird C., Borisuk M.J., Sanders S.P., Padera R.F. Jr. Histology of pericardial tissue substitutes used in congenital heart surgery.
Pediatr. Dev. Pathol. 2016; 19 (5): 383–388. DOI: 10.2350/15-08-1696-OA.1
- Nordmeyer S., Murin P., Schulz A., Danne F., Nordmeyer J., Kretzschmar J. et al. Results of aortic valve repair using decellularized bovine pericardium in congenital surgery. Eur. J. Cardiothorac. Surg. 2018; 54 (6): 986–992. DOI: 10.1093/ejcts/ezy181
- Bell D., Betts K., Justo R., Forde N., Venugopal P., Corno A.F. et al. experience with 500 CardioCel implants used for the repair of congenital heart defects. Ann. Thorac. Surg. 2019; 108 (6): 1883–1888. DOI: 10.1016/j.athoracsur.2019.04.085
- d’Udekem Y., Siddiqui J., Seaman C.S., Konstantinov I.E., Galati J.C., Cheung M.M., Brizard C.P. Long-term results of a strategy of aortic valve repair in the pediatric population. J. Thorac. Cardiovasc. Surg. 2013; 145 (2): 461–467; discussion 467–469. DOI: 10.1016/j. jtcvs.2012.11.033
- Giannopoulos A.A., Mitsouras D., Yoo S.J., Liu P.P., Chatzizisis Y.S., Rybicki F.J. Applications of 3D printing in cardiovascular diseases. Nat. Rev. Cardiol. 2016; 13 (12): 701–718. DOI: 10.1038/nrcardio.2016.170
- Vukicevic M., Mosadegh B., Min J.K., Little S.H. Cardiac 3D Printing and its Future Directions. JACC Cardiovasc. Imaging. 2017; 10 (2): 171–184. DOI: 10.1016/j.jcmg.2016.12.001
- Shearn A.I.U., Ordoñez M.V., Rapetto F., Caputo M., Biglino G. Rapid prototyping flexible aortic models aids sizing of valve leaflets and planning the Ozaki repair. JACC Case Rep. 2020; 2 (8): 1137–1140. DOI: 10.1016/j.jaccas.2020.04.054
- Tsiskaridze I.M., Skopin I.I., Svobodov A.A. The practice of using three-dimensional imaging in adult patients with cardiovascular pathology – experience Bakulev Scientific Centre of Cardiovascular Surgery. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2023; 24 (S6): 23 (in Russ.).
- Svobodov A.A., Gulasaryan R.S., Armaganova A.A., Volkov S.S., Shilkin D.N., Chernykh N.A. 3D modeling to determine the tactics of surgical treatment of complex congenital heart disease with an anomaly of the location and formation of the heart. Grudnaya i Serdechno- Sosudistaya Khirurgiya. 2023; 65 (1): 119–123 (in Russ.). DOI: 10.24022/0236-2791-2023-65-1-119-123
- Gushchin D.K., Shilkin D.N., Volkov S.S., Zelenikin M.M. Use of 3D-modeling and 3D-printing in the surgical planning of univentricular repair of complex congenital heart disease in a 1 year 7 month old child. Children’s Heart and Vascular Diseases. 2022; 19 (3): 236–238 (in Russ.). DOI: 10.24022/1810-0686-2022-19-3-236-238
About the authors
- Aleksei E. Chernogrivov, Dr. Med. Sci., Cardiovascular Surgeon; ORCID
- Erik A. Shaknazaryan, Junior Reseacher; ORCID
- Dmitriy N. Shilkin, Cardiovascular Surgeon; ORCID
- Inessa E. Nefedova, Dr. Med. Sci., Cardiologist, Head of Department of Emergency Surgery in Premature Newborns and Infants (up to 1 y.o.) with Congenital Heart Defects; ORCID