Abstract
Objective: to study the morphological features of the aortic valve and evaluate the effect of various types of anatomy on the results of surgery and the frequency of reoperations in infants.
Material and methods. From 2008 to 2019 55 surgical interventions for congenital aortic valve stenosis in patients under 1 year of age were performed at the Federal State Budget Center “Federal Center for Cardiovascular Surgery” the Ministry of Health of the Russian Federation (Penza). In all cases, the bicuspid structure of the aortic valve (AV) were determined, according to the classification (H. Sievers, C. Schmidtke, 2007), 3 groups were divided depending on the type of AV: group 1 (type 0) – 10 (18,%) cases, group 2 (type 1) – 38 (69.1%) cases, group 3 (type 2) – 7 (12.7%) cases. The median age at the time of surgery was 26 days, including 35 newborns. In 53 (78%) cases, “expanded” valvuloplasty were performed, 10 (18%) patients had commissurotomy, and 2 (4%) patients underwent tricuspidization of bicuspid AV.
Results. There was no in-hospital mortality. Repeated open-heart surgery were required in 4 (7.3%) patients. Actuarial freedom from reoperations at follow-up periods up to 10 years was 100%; 97 ± 2%; 40 ± 21, for patients of groups 1, 2 and 3, respectively (p = 0.016). A statistically significant effect of type 2 on a higher probability of aortic valve restenosis in the long term and therefore reoperation (OR 11.9; CI 1.2–23.2; p = 0.025) was revealed.
Conclusions. Open-heart procedure repair of AV stenosis as a primary procedure is possible in all cases; however, valve morphology in newborns and infants has a significant clinical effect. It is necessary to meticulous preoperative evaluation of AV morphology to identify patients with negative predictive signs, for example type 2 of AV.
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About the authors
- Aleksey E. Chernogrivov, Dr. Med. Sc., Head of Department, ORCID
- Dmitriy A. Bofanov, Cardiovascular Surgeon, ORCID
- Igor’ E. Chernogrivov, Dr. Med. Sc., Cardiovascular Surgeon,
ORCID
- Irina S. Nazarova, Pediatric Cardiologist, ORCID
- Vladlen V. Bazylev, Dr. Med. Sc., Chief Physicion, ORCID
