Congenital aortic valve (AoV) repair outcomes are hampered by the gradual failure of leaflet replacement materials currently in use. For a study, researchers contrasted the long-term effects of congenital AoV repair with autologous pericardium (AP) vs porcine intestinal submucosa.
All patients who underwent congenital AoV repair using either porcine intestinal submucosa or AP between October 2009 and March 2013 were included in the single-center retrospective evaluation. Postdischarge (late) unplanned AoV reintervention was the main result. The quantity of late AoV reinterventions and a composite of at least mild aortic regurgitation or stenosis at the most recent follow-up or prior to the first reintervention were secondary outcomes. By correcting for predetermined patient-related and operational factors, multivariable regression models were used to determine associations between leaflet repair material and outcomes.
The median age was 11.0 years (IQR: 4.7-16.6 years) among 49 AP patients and 26 porcine intestinal submucosa patients who satisfied entrance requirements. About 22 (44.9%) AP patients and 17 (65.4%) porcine intestinal submucosa patients experienced at least one AoV reintervention at a median follow-up of 8.5 years (IQR: 4.4-9.6 years). In a multivariate analysis, the use of porcine intestinal submucosa was significantly related to unplanned AoV reintervention (HR: 4.6; 95% CI: 2.2-9.8; P<0.001), the number of postdischarge AoV reinterventions (incidence rate ratio: 1.7; 95% CI: 1.0-2.9; P = 0.037), and at least moderate aortic regurgitation or stenosis at latest follow-up or before the first reintervention (OR: 5.0; 95% CI: 1.2-21.0; P = 0.027).
When compared to the autologous pericardium, aortic valvuloplasty with porcine intestinal submucosa resulted in a shorter period before reintervention.