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Multicentre comparative analysis of long-term outcomes after aortic valve replacement in children.

Authors
  • Knight, Jessica H1
  • Sarvestani, Amber Leila2
  • Ibezim, Chizitam2
  • Turk, Elizabeth2
  • McCracken, Courtney E3
  • Alsoufi, Bahaaldin4
  • St Louis, James5
  • Moller, James H6
  • Raghuveer, Geetha2
  • Kochilas, Lazaros K3, 7
  • 1 Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA [email protected] , (Georgia)
  • 2 Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
  • 3 Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA. , (Georgia)
  • 4 Department of Surgery, University of Louisville, Louisville, Kentucky, USA.
  • 5 Department of Surgery, Augusta University Medical College of Georgia, Augusta, Georgia, USA. , (Georgia)
  • 6 School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
  • 7 Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. , (Georgia)
Type
Published Article
Journal
Heart
Publisher
BMJ
Publication Date
May 25, 2022
Volume
108
Issue
12
Pages
940–947
Identifiers
DOI: 10.1136/heartjnl-2021-319597
PMID: 34611043
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The ideal valve substitute for surgical intervention of congenital aortic valve disease in children remains unclear. Data on outcomes beyond 10-15 years after valve replacement are limited but important for evaluating substitute longevity. We aimed to describe up to 25-year death/cardiac transplant by type of valve substitute and assess the potential impact of treatment centre. Our hypothesis was that patients with pulmonic valve autograft would have better survival than mechanical prosthetic. This is a retrospective cohort study from the Pediatric Cardiac Care Consortium, a multi-institutional US-based registry of paediatric cardiac interventions, linked with the National Death Index and United Network for Organ Sharing through 2019. Children (0-20 years old) receiving aortic valve replacement (AVR) from 1982 to 2003 were identified. Kaplan-Meier transplant-free survival was calculated, and Cox proportional hazard models estimated hazard ratios for mechanical AVR (M-AVR) versus pulmonic valve autograft. Among 911 children, the median age at AVR was 13.4 years (IQR=8.4-16.5) and 73% were male. There were 10 cardiac transplants and 153 deaths, 5 after transplant. The 25-year transplant-free survival post AVR was 87.1% for autograft vs 76.2% for M-AVR and 72.0% for tissue (bioprosthetic or homograft). After adjustment, M-AVR remained related to increased mortality/transplant versus autograft (HR=1.9, 95% CI=1.1 to 3.4). Surprisingly, survival for patients with M-AVR, but not autograft, was lower for those treated in centres with higher in-hospital mortality. Pulmonic valve autograft provides the best long-term outcomes for children with aortic valve disease, but AVR results may depend on a centre's experience or patient selection. © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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