OBJECTIVE:Aortic cusp extension valvuloplasty(ACEV), despite being technically demanding, is increasingly employed in the management of children and adolescents with aortic stenosis or regurgitation. The durability of this approach and the freedom from valve replacement are not, yet, well defined. A study was undertaken to investigate outcomes.

METHODS:From July 1987 to November 2008, 142 patients younger than 19 years of age underwent ACEV in the form of tricuspidization with pericardial cusp extension. From the available follow-up data recurrent aortic regurgitation or stenosis or both (from previous congenital aortic stenosis with or without bicuspid aortic valve) was the diagnosis in 135 cases and 7 had other diagnosis. Median follow-up was 14.4 years (0.1 to 21.4). Long-term mortality and freedom from Ross procedure or other valve replacement were studied.

RESULTS:There were no early, intermediate or late deaths. Mean z-scores of left ventricular end-diastolic dimension, aortic annulus, aortic sinus diameter and sinotubular junction diameter prior to aortic valve replacement were 4.2+/-3.1, 2.3+/-1.25, 4.4+/-1.2, 1.84+/-1.28, respectively. In 25 of 142 ACEV(17.6%) Ross operation was performed. Other aortic valve replacement was undertaken after 15 ACEV(10.6%). Freedom from any type of aortic valve replacement at 20 years was 71.83+/-3.77%. In particularly, freedom from Ross procedure at 20 years was 82.39+/-3.2%.

CONCLUSION:Aortic valvuloplasty with tricuspidization and cusp extension is a safe and effective surgical option with excellent survival and good long-term outcomes in children and adolescents willing to accept the risk for reoperation. It provides acceptable durability and satisfactory freedom from aortic valve replacement