Long-Term Clinical and Echocardiographic Follow-Up After Aortic Valve Tricuspidization With Polytetrafluoroethylene in Children: 15-Year Experience at a Single Center

Abstract

Objectives

Aortic valve repair by tricuspidization with leaflet extensions is utilized in the management of aortic valve disease in children and adolescents. The aim of this study is to evaluate the long-term outcomes following aortic valve tricuspidization using polytetrafluoroethylene (PTFE) leaflet extensions at a single center.

Methods

We conducted a retrospective single-center analysis of 50 patients who underwent aortic valvuloplasty by tricuspidization with PTFE leaflet extensions between 2008 and 2024.

Results

Fifty patients (37/50, 74% female) underwent aortic valvuloplasty using PTFE. The median age was 13 (interquartile range [IQR]: 1.8-25) years. During the median follow-up duration of 8.5 years (IQR: 8 months-15.8 years), 18 patients required reoperation at a mean of 7.3 ± 4 years. The 15-year survival rate was 95.6% (95% confidence interval [CI], 88%-98.8%), and 2 late deaths occurred. The freedom from reoperation at 1, 5, and 12 years was 100% (95% CI, 100%-100%), 82.8% (95% CI, 66.6%-91.4%), and 44.2% (95% CI, 26.2%-61%), respectively. At discharge, the mean peak systolic aortic valve gradients (15 ± 10 mm Hg) were significantly lower than preoperative (72 ± 35 mm Hg) values (P < .001). Mean of left ventricular end-diastolic diameter/body surface area index decreased from 38 ± 13 mm preoperatively to 34.4 ± 10.5 mm postoperatively, then reduced to 32 ± 7 mm at the latest follow-up (P = .003). Aortic regurgitation improved in all patients, and none had more than mild aortic regurgitation at hospital discharge.

Conclusions

Aortic leaflet extension valvuloplasty using PTFE is effective, safe, with excellent survival and favorable long-term outcomes. It provides reliable palliation in patients with congenital aortic valve diseases until a more permanent replacement alternative is available.

Keywords

aortic leaflet extension valvuloplasty congenital aortic valve disease tricuspidization‌polytetrafluoroethylene

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