Commentary: From bioprosthetic tissue degeneration to regeneration: A new surgical horizon in the era of regenerative medicine

The ideal aortic valve surgery in children must result in an unobstructed, competent aortic valve that is also durable and accommodates growth of the child. Intuitively, aortic valve surgery in children must emulate native aortic valve anatomy and physiology as close as possible, preferably using autologous tissues with growth potential. The optimal approach to aortic valve surgery in children is yet to be defined. The purpose of this focused review is to highlight recent key publications on the topic. AORTIC VALVE REPAIRAortic valve repair is currently performed in children with increasingly good results. 1 Last year, outstanding results of aortic valve repair in neonates were reported by Vergnat and colleagues 2 in neonates with congenital aortic stenosis treated between 1989 and 2015. Of these patients, 52 underwent surgical aortic valve repair and 51 underwent balloon aortic dilatation. There was similar early mortality (7.8% for ballooning vs 3.9% for repair) and 10-year survival (88% for ballooning vs 94% for surgery, P ¼ .25). However, freedom from reoperation was superior in the group undergoing aortic valve repair (66% vs 36%, P < .01). Similar results have been reported by Siddiqui and colleagues 3 for neonates and infants. Thus, it appears that the outcomes of aortic valve repair in neonates and infants are superior to those achieved by balloon dilation.In children aged more than 1 year, the operative mortality for aortic valve repair is 0.4% to 1.8% and freedom from reoperation is approximately 70% at 10 years. 4 d'Udekem and colleagues 5 reported 142 children who underwent aortic valve repairs between 1996 and 2009 at a median age of 9 years. Early mortality was 1.8% in children aged more than 1 year. Freedom from reoperation was 80% at 7 years follow-up. The use of cusp extension was associated with increased risk of reoperation.

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“…If this technique could be modified using bioengineered tissue with regeneration and growth potential, it may become valuable in the future. 17…”

Section: Ozaki Aortic Valve Replacementmentioning

confidence: 99%

Aortic valve surgery in children

Buratto

Konstantinov

2021

The Journal of Thoracic and Cardiovascular Surgery

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“…It is fascinating and somewhat bewildering to think that autologous tissue with the ability to regenerate may become available in the future. 11 If Ozaki valve replacement could be modified using autologous tissue with preserved growth capacity and preserved regenerative ability to ensure resistance to calcification, it may prove to be an extremely valuable technique in selected patients. Until then, it will remain a valve replacement with the expected outcomes similar to those of biological prostheses or homografts.…”

Section: Central Messagementioning

confidence: 99%

Commentary: Ozaki valve reconstruction in children: Is it still a valve replacement?

Konstantinov

Naimo

Buratto

2021

The Journal of Thoracic and Cardiovascular Surgery

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AVRec, especially in the absence of long-term data. A wellexecuted Ross procedure would be much more indicated here. Other settings in which a Ross or Ross-Konno procedure seems to be better suited would be the subsets of cases in which additional aortic annular enlargement (n ¼ 8) or aortic sinus enlargement (n ¼ 20) was required. The added geometric complexity will make the procedure less reproducible, and my guess is less reliable, in the long term.In conclusion, this is an important spearhead series. Busy, high-volume centers should perform it, refine it, and report on it. Until we see midterm results at least, however, one cannot advocate for the wide generalization of the AVRec in pediatric cardiac surgery. References

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“… 10 , 11 Less immunogenic materials and improved processing methods have already been described to increase biocompatibility and to prevent an immunologic response to the xenogenic valve tissue. 9 , 11 It appears that a proper understanding of alpha-gal syndrome is important to improve the longevity of bioprosthetic material 13 , 14 , 15 , 16 , 17 in patients with a wide range of congenital and acquired heart disease.…”

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confidence: 99%

Commentary: From Old World monkeys to New World humans—Evolved protection from tick bites and bioprosthetic material

2021

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Commentary: From bioprosthetic tissue degeneration to regeneration: A new surgical horizon in the era of regenerative medicine

Abstract: Statins and macrophages in bioprosthetic valve degeneration. Central Message Statins may decrease calcification of biologic tissue valve prostheses. Macrophages may play a key role in biologic valvular tissue longevity.

Cited by 5 publications

References 8 publications

Aortic valve surgery in children

Aortic valve surgery in children

Commentary: Ozaki valve reconstruction in children: Is it still a valve replacement?

Commentary: From Old World monkeys to New World humans—Evolved protection from tick bites and bioprosthetic material

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