Cor Vasa 2025, 67(1):16-23 | DOI: 10.33678/cor.2024.105

18-Year Outcomes of Aortic Leaflet Extension Valvuloplasty Using Autologous Pericardium and Polytetrafluoroethylene: Single-Centre, Propensity-Matched Analysis

Matej Nosáľ^{a, b}, Fadi Sabateen^a, Pavel Valentík^a, Michal Šagát^a, Aref Saif Nagi^a, Kristína Kasičová^a, Vladimír Soják^a

^a Department of Pediatric Cardiac Surgery, Children's Heart Centre, National Institute of Cardiovascular Diseases, Bratislava, Slovakia

^b Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia

Background: Aortic valve repair with leaflet extension is routinely utilized in the management of aortic valve disease in children and adolescents. The material chosen may have an effect on the valve function and durability.

Aims: To evaluate long-term outcomes of aortic valve repair using autologous pericardium and polytetrafluoroethylene (PTFE) leaflet extensions and to investigate risk factors for aortic valve reoperation at single centre.

Methods: A retrospective single-centre review of 89 patients undergoing aortic valvuloplasty by leaflet extensions with either autologous pericardium or PTFE from 2005 to 2023.

Results: Eighty-nine patients (75% male) underwent aortic leaflet extension valvuloplasty, using either autologous pericardium (n = 42) or PTFE (n = 47). Median age was 14 years (IQR: 7 months-26 years). During median follow-up duration of 13.3 years (IQR: 1 month-18 years), there were 4 deaths and 41 (46%) patients required reoperation at a mean of 7.8 ± 4.2 years, 24 (57%) within autologous pericardium group, and 17 (36%) within PTFE group. Overall survival at 18 years was 95%. Overall reoperation-free survival at 5, 10 and 15 years was 87.6%, 57%, and 35.4%, respectively. Multivariable Cox analysis identified primary diagnosis of aortic regurgitation, aortic annulus diameter, infective endocarditis, aortic cross-clamp and cardiopulmonary bypass time, and preoperative aortic surgical valvuloplasty as risk factors for aortic valve reoperation.

Conclusions: Long-term results of aortic leaflet extension valvuloplasty, utilizing either autologous pericardium or PTFE, in patients with congenital aortic valve disease suggest excellent survival with no significant difference in the reoperation rate for aortic valve dysfunction between the groups.

Keywords: Aortic leaflet extension valvuloplasty, Congenital aortic valve disease, Polytetrafluoroethylene, Propensity score matching, Tricuspidalization

Received: November 9, 2024; Revised: December 5, 2024; Accepted: December 17, 2024; Prepublished online: June 2, 2012; Published: March 1, 2025  Show citation