Chinese expert consensus on surgical treatment of aortic valve disease in children_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Hao ¹ , YANG Keming ² ,  CHEN Xinxin ³ ,  DONG Nianguo ⁴ ,  LI Shoujun ² , National Society of Congenital Heart Diseases

1. Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200000, P. R. China;
2. Department of Pediatric Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China;
3. Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou, 511400, P. R. China;
4. Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430021, P. R. China;

Corresponding author：

CHEN Xinxin, Email: zingerchen@163.com; DONG Nianguo, Email: dongnianguo@hotmail.com; LI Shoujun, Email: drlishoujunfw@163.com

Keywords：

Congenital heart diseases; aortic valve disease in children; expert consensus

DOI：

10.7507/1007-4848.202409084

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

The consensus was authored by National Society of Congenital Heart Diseases. After employing the Delphi process and incorporating literature reviews and expert discussions, seven recommendations were ultimately formulated. The consensus provides a detailed elaboration on the pathoanatomy, pathophysiology, clinical manifestations, diagnostic methods, and surgical treatment approaches for aortic valve diseases in children. It emphasizes that the treatment of aortic valve diseases in children should take into account the needs of growth and development, and recommends surgical strategies for different age groups and types of lesions, including valve plasty, Ross procedure, valve replacement, and balloon dilation. Specifically, aortic valve plasty is recommended for neonates and infants, while surgical options for older children are more diversified. The consensus only discusses isolated aortic valve disease and does not cover cases complicated with other heart malformations.

Citation： ZHANG Hao, YANG Keming, CHEN Xinxin, DONG Nianguo, LI Shoujun, National Society of Congenital Heart Diseases. Chinese expert consensus on surgical treatment of aortic valve disease in children. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(11): 1560-1566. doi: 10.7507/1007-4848.202409084 Copy

1.	Yasuhara J, Schultz K, Bigelow AM, et al. Congenital aortic valve stenosis: From pathophysiology to molecular genetics and the need for novel therapeutics. Front Cardiovasc Med, 2023, 10: 1142707.
2.	Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart defects 1970-2017: Updated systematic review and meta-analysis of 260 studies. Int J Epidemiol, 2019, 48(2): 455-463.
3.	Ehrlich T, de Kerchove L, Vojacek J, et al. State-of-the art bicuspid aortic valve repair in 2020. Prog Cardiovasc Dis, 2020, 63(4): 457-464.
4.	Baird CW, Cooney B, Chávez M, et al. Congenital aortic and truncal valve reconstruction using the Ozaki technique: Short-term clinical results. J Thorac Cardiovasc Surg, 2021, 161(5): 1567-1577.
5.	Lancaster TS, Romano JC, Si MS, et al. Aortic valve repair using geometric ring annuloplasty in pediatric and congenital heart disease patients. J Thorac Cardiovasc Surg, 2023, 166(2): 294-303.
6.	Rowe G, Gill G, Zubair MM, et al. Ross procedure in children: The Society of Thoracic Surgeons Congenital Heart Surgery Database analysis. Ann Thorac Surg, 2023, 115(1): 119-125.
7.	Buratto E, Konstantinov IE. Aortic valve surgery in children. J Thorac Cardiovasc Surg, 2020, S0022-5223.
8.	Saikrishnan N, Yap CH, Milligan NC, et al. In vitro characterization of bicuspid aortic valve hemodynamics using particle image velocimetry. Ann Biomed Eng, 2012, 40(8): 1760-1775.
9.	Otto CM, Prendergast B. Aortic-valve stenosis—From patients at risk to severe valve obstruction. N Engl J Med, 2014, 371(8): 744-756.
10.	Carapetis JR, Beaton A, Cunningham MW, et al. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers, 2016, 2: 15084.
11.	Lloyd DFA, Pushparajah K, Simpson JM, et al. Three-dimensional visualisation of the fetal heart using prenatal MRI with motion-corrected slice-volume registration: A prospective, single-centre cohort study. Lancet, 2019, 393(10181): 1619-1627.
12.	Hopkins MK, Dugoff L, Kuller JA. Congenital heart disease: Prenatal diagnosis and genetic associations. Obstet Gynecol Surv, 2019, 74(8): 497-503.
13.	Bonnichsen C, Ammash N. Choosing between MRI and CT imaging in the adult with congenital heart disease. Curr Cardiol Rep, 2016, 18(5): 45.
14.	Rizk J. 4D flow MRI applications in congenital heart disease. Eur Radiol, 2021, 31(2): 1160-1174.
15.	Siegel MJ. Cardiac CTA: Congenital heart disease. Pediatr Radiol, 2008, 38 (Suppl 2): S200-S204.
16.	Miranda WR, Aboulhosn JA, Hagler DJ. Catheterization in adults with congenital heart disease: A primer for the noncongenital proceduralist. JACC Cardiovasc Interv, 2022, 15(9): 907-921.
17.	Holzer RJ, Bergersen L, Thomson J, et al. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert consensus statement on cardiac catheterization for pediatric patients and adults with congenital heart disease. J Soc Cardiovasc Angiogr Interv, 2023, 3(1): 101181.
18.	Feltes TF, Bacha E, Beekman RH, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: A scientific statement from the American Heart Association. Circulation, 2011, 123(22): 2607-2652.
19.	Yang MC, Chen CA, Chiu HH, et al. Assessing utility of exercise test in determining exercise prescription in adolescent and adult patients with repaired tetralogy of Fallot. Heart Vessels, 2017, 32(2): 201-207.
20.	Barfuss SB, Boucek DM, McFarland CA, et al. Short-term left ventricular reverse remodeling after transcatheter aortic valve replacement in children. J Am Soc Echocardiogr, 2022, 35(10): 1077-1083.
21.	Wallace F, Buratto E, Schulz A, et al. Long-term outcomes of primary aortic valve repair for isolated congenital aortic stenosis in children. J Thorac Cardiovasc Surg, 2022, 164(5): 1263-1274.
22.	McMullan DM, Oppido G, Davies B, et al. Surgical strategy for the bicuspid aortic valve: Tricuspidization with cusp extension versus pulmonary autograft. J Thorac Cardiovasc Surg, 2007, 134(1): 90-98.
23.	Danial P, Neily A, Pontailler M, et al. Ross procedure or complex aortic valve repair using pericardium in children: A real dilemma. J Thorac Cardiovasc Surg, 2022, 163(3): 1180-1191.
24.	Zhu MZL, Konstantinov IE, Wu DM, et al. Aortic valve repair versus the Ross procedure in children. J Thorac Cardiovasc Surg, 2023, 166(5): 1279-1288.
25.	Cleveland JD, Bansal N, Wells WJ, et al. Ross procedure in neonates and infants: A valuable operation with defined limits. J Thorac Cardiovasc Surg, 2023, 165(1): 262-272.
26.	Aszyk P, Thiel C, Sinzobahamvya N, et al. Ross-Konno procedure in infants: Mid-term results. Eur J Cardiothorac Surg, 2012, 42(4): 687-694.
27.	Myers PO, Mokashi SA, Horgan E, et al. Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart disease. J Thorac Cardiovasc Surg, 2019, 157(1): 329-340.
28.	Vergnat M, Asfour B, Arenz C, et al. Aortic stenosis of the neonate: A single-center experience. J Thorac Cardiovasc Surg, 2019, 157(1): 318-326.
29.	Hill GD, Ginde S, Rios R, et al. Surgical valvotomy versus balloon valvuloplasty for congenital aortic valve stenosis: A systematic review and meta-analysis. J Am Heart Assoc, 2016, 5(8): e003931.
30.	Siddiqui J, Brizard CP, Galati JC, et al. Surgical valvotomy and repair for neonatal and infant congenital aortic stenosis achieves better results than interventional catheterization. J Am Coll Cardiol, 2013, 62(22): 2134-2140.
31.	Sames-Dolzer E, Wickenhauser E, Kreuzer M, et al. The Ross-Konno procedure in neonates and infants less than 3 months of age. Eur J Cardiothorac Surg, 2018, 54(1): 71-77.
32.	Luxford JC, Ayer JG, Betts K, et al. The Ross/Ross-Konno procedure in infancy is a safe and durable solution for aortic stenosis. J Thorac Cardiovasc Surg, 2022, 163(2): 365-375.
33.	Donald JS, Wallace FRO, Naimo PS, et al. Ross operation in children: 23-year experience from a single institution. Ann Thorac Surg, 2020, 109(4): 1251-1259.
34.	Lo Rito M, Davies B, Brawn WJ, et al. Comparison of the Ross/Ross-Konno aortic root in children before and after the age of 18 months. Eur J Cardiothorac Surg, 2014, 46(3): 450-457.
35.	Buratto E, Wallace FRO, Fricke TA, et al. Ross procedures in children with previous aortic valve surgery. J Am Coll Cardiol, 2020, 76(13): 1564-1573.
36.	Konstantinov IE, Naimo PS, Buratto E. Commentary: Ozaki valve reconstruction in children: Is it still a valve replacement? J Thorac Cardiovasc Surg, 2021, 161(5): 1579-1581.
37.	Wiggins LM, Mimic B, Issitt R, et al. The utility of aortic valve leaflet reconstruction techniques in children and young adults. J Thorac Cardiovasc Surg, 2020, 159(6): 2369-2378.
38.	Fraser CD, Liu RH, Zhou X, et al. Valve-sparing aortic root replacement in children: Outcomes from 100 consecutive cases. J Thorac Cardiovasc Surg, 2019, 157(3): 1100-1109.
39.	Schulz A, Buratto E, Wallace FRO, et al. Outcomes of aortic valve repair in children resulting in bicuspid anatomy: Is there a need for tricuspidization? J Thorac Cardiovasc Surg, 2022, 164(1): 186-196.
40.	Arnold R, Ley-Zaporozhan J, Ley S, et al. Outcome after mechanical aortic valve replacement in children and young adults. Ann Thorac Surg, 2008, 85(2): 604-610.
41.	Etnel JR, Elmont LC, Ertekin E, et al. Outcome after aortic valve replacement in children: A systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2016, 151(1): 143-152.
42.	Buratto E, Wallace F, Schulz A, et al. The Ross procedure in children: Defining the optimal age. Heart Lung Circ, 2023, 32(6): 745-749.
43.	Sharabiani MT, Dorobantu DM, Mahani AS, et al. Aortic valve replacement and the Ross operation in children and young adults. J Am Coll Cardiol, 2016, 67(24): 2858-2870.
44.	Zarate YA, Sellars E, Lepard T, et al. Aortic dilation in pediatric patients. Eur J Pediatr, 2015, 174(12): 1585-1592.
45.	Mariucci E, Donti A, Guidarini M, et al. Diagnostic accuracy of aortic root cross-sectional area/height ratio in children and young adults with Marfan and Loeys-Dietz syndrome. Congenit Heart Dis, 2016, 11(3): 276-282.
46.	Siurana JM, Sabaté-Rotés A, Ayerza A, et al. Adolescents with bicuspid aortic valve: Which criteria should we use for aortic dilatation? Int J Cardiol, 2021, 333: 90-93.
47.	Rodriguez M, Malvea A, McNally D, et al. Aortic valve intervention during aortic root surgery in children: A systematic review. World J Pediatr Congenit Heart Surg, 2020, 11(5): 611-618.

1. Yasuhara J, Schultz K, Bigelow AM, et al. Congenital aortic valve stenosis: From pathophysiology to molecular genetics and the need for novel therapeutics. Front Cardiovasc Med, 2023, 10: 1142707.
2. Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart defects 1970-2017: Updated systematic review and meta-analysis of 260 studies. Int J Epidemiol, 2019, 48(2): 455-463.
3. Ehrlich T, de Kerchove L, Vojacek J, et al. State-of-the art bicuspid aortic valve repair in 2020. Prog Cardiovasc Dis, 2020, 63(4): 457-464.
4. Baird CW, Cooney B, Chávez M, et al. Congenital aortic and truncal valve reconstruction using the Ozaki technique: Short-term clinical results. J Thorac Cardiovasc Surg, 2021, 161(5): 1567-1577.
5. Lancaster TS, Romano JC, Si MS, et al. Aortic valve repair using geometric ring annuloplasty in pediatric and congenital heart disease patients. J Thorac Cardiovasc Surg, 2023, 166(2): 294-303.
6. Rowe G, Gill G, Zubair MM, et al. Ross procedure in children: The Society of Thoracic Surgeons Congenital Heart Surgery Database analysis. Ann Thorac Surg, 2023, 115(1): 119-125.
7. Buratto E, Konstantinov IE. Aortic valve surgery in children. J Thorac Cardiovasc Surg, 2020, S0022-5223.
8. Saikrishnan N, Yap CH, Milligan NC, et al. In vitro characterization of bicuspid aortic valve hemodynamics using particle image velocimetry. Ann Biomed Eng, 2012, 40(8): 1760-1775.
9. Otto CM, Prendergast B. Aortic-valve stenosis—From patients at risk to severe valve obstruction. N Engl J Med, 2014, 371(8): 744-756.
10. Carapetis JR, Beaton A, Cunningham MW, et al. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers, 2016, 2: 15084.
11. Lloyd DFA, Pushparajah K, Simpson JM, et al. Three-dimensional visualisation of the fetal heart using prenatal MRI with motion-corrected slice-volume registration: A prospective, single-centre cohort study. Lancet, 2019, 393(10181): 1619-1627.
12. Hopkins MK, Dugoff L, Kuller JA. Congenital heart disease: Prenatal diagnosis and genetic associations. Obstet Gynecol Surv, 2019, 74(8): 497-503.
13. Bonnichsen C, Ammash N. Choosing between MRI and CT imaging in the adult with congenital heart disease. Curr Cardiol Rep, 2016, 18(5): 45.
14. Rizk J. 4D flow MRI applications in congenital heart disease. Eur Radiol, 2021, 31(2): 1160-1174.
15. Siegel MJ. Cardiac CTA: Congenital heart disease. Pediatr Radiol, 2008, 38 (Suppl 2): S200-S204.
16. Miranda WR, Aboulhosn JA, Hagler DJ. Catheterization in adults with congenital heart disease: A primer for the noncongenital proceduralist. JACC Cardiovasc Interv, 2022, 15(9): 907-921.
17. Holzer RJ, Bergersen L, Thomson J, et al. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert consensus statement on cardiac catheterization for pediatric patients and adults with congenital heart disease. J Soc Cardiovasc Angiogr Interv, 2023, 3(1): 101181.
18. Feltes TF, Bacha E, Beekman RH, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: A scientific statement from the American Heart Association. Circulation, 2011, 123(22): 2607-2652.
19. Yang MC, Chen CA, Chiu HH, et al. Assessing utility of exercise test in determining exercise prescription in adolescent and adult patients with repaired tetralogy of Fallot. Heart Vessels, 2017, 32(2): 201-207.
20. Barfuss SB, Boucek DM, McFarland CA, et al. Short-term left ventricular reverse remodeling after transcatheter aortic valve replacement in children. J Am Soc Echocardiogr, 2022, 35(10): 1077-1083.
21. Wallace F, Buratto E, Schulz A, et al. Long-term outcomes of primary aortic valve repair for isolated congenital aortic stenosis in children. J Thorac Cardiovasc Surg, 2022, 164(5): 1263-1274.
22. McMullan DM, Oppido G, Davies B, et al. Surgical strategy for the bicuspid aortic valve: Tricuspidization with cusp extension versus pulmonary autograft. J Thorac Cardiovasc Surg, 2007, 134(1): 90-98.
23. Danial P, Neily A, Pontailler M, et al. Ross procedure or complex aortic valve repair using pericardium in children: A real dilemma. J Thorac Cardiovasc Surg, 2022, 163(3): 1180-1191.
24. Zhu MZL, Konstantinov IE, Wu DM, et al. Aortic valve repair versus the Ross procedure in children. J Thorac Cardiovasc Surg, 2023, 166(5): 1279-1288.
25. Cleveland JD, Bansal N, Wells WJ, et al. Ross procedure in neonates and infants: A valuable operation with defined limits. J Thorac Cardiovasc Surg, 2023, 165(1): 262-272.
26. Aszyk P, Thiel C, Sinzobahamvya N, et al. Ross-Konno procedure in infants: Mid-term results. Eur J Cardiothorac Surg, 2012, 42(4): 687-694.
27. Myers PO, Mokashi SA, Horgan E, et al. Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart disease. J Thorac Cardiovasc Surg, 2019, 157(1): 329-340.
28. Vergnat M, Asfour B, Arenz C, et al. Aortic stenosis of the neonate: A single-center experience. J Thorac Cardiovasc Surg, 2019, 157(1): 318-326.
29. Hill GD, Ginde S, Rios R, et al. Surgical valvotomy versus balloon valvuloplasty for congenital aortic valve stenosis: A systematic review and meta-analysis. J Am Heart Assoc, 2016, 5(8): e003931.
30. Siddiqui J, Brizard CP, Galati JC, et al. Surgical valvotomy and repair for neonatal and infant congenital aortic stenosis achieves better results than interventional catheterization. J Am Coll Cardiol, 2013, 62(22): 2134-2140.
31. Sames-Dolzer E, Wickenhauser E, Kreuzer M, et al. The Ross-Konno procedure in neonates and infants less than 3 months of age. Eur J Cardiothorac Surg, 2018, 54(1): 71-77.
32. Luxford JC, Ayer JG, Betts K, et al. The Ross/Ross-Konno procedure in infancy is a safe and durable solution for aortic stenosis. J Thorac Cardiovasc Surg, 2022, 163(2): 365-375.
33. Donald JS, Wallace FRO, Naimo PS, et al. Ross operation in children: 23-year experience from a single institution. Ann Thorac Surg, 2020, 109(4): 1251-1259.
34. Lo Rito M, Davies B, Brawn WJ, et al. Comparison of the Ross/Ross-Konno aortic root in children before and after the age of 18 months. Eur J Cardiothorac Surg, 2014, 46(3): 450-457.
35. Buratto E, Wallace FRO, Fricke TA, et al. Ross procedures in children with previous aortic valve surgery. J Am Coll Cardiol, 2020, 76(13): 1564-1573.
36. Konstantinov IE, Naimo PS, Buratto E. Commentary: Ozaki valve reconstruction in children: Is it still a valve replacement? J Thorac Cardiovasc Surg, 2021, 161(5): 1579-1581.
37. Wiggins LM, Mimic B, Issitt R, et al. The utility of aortic valve leaflet reconstruction techniques in children and young adults. J Thorac Cardiovasc Surg, 2020, 159(6): 2369-2378.
38. Fraser CD, Liu RH, Zhou X, et al. Valve-sparing aortic root replacement in children: Outcomes from 100 consecutive cases. J Thorac Cardiovasc Surg, 2019, 157(3): 1100-1109.
39. Schulz A, Buratto E, Wallace FRO, et al. Outcomes of aortic valve repair in children resulting in bicuspid anatomy: Is there a need for tricuspidization? J Thorac Cardiovasc Surg, 2022, 164(1): 186-196.
40. Arnold R, Ley-Zaporozhan J, Ley S, et al. Outcome after mechanical aortic valve replacement in children and young adults. Ann Thorac Surg, 2008, 85(2): 604-610.
41. Etnel JR, Elmont LC, Ertekin E, et al. Outcome after aortic valve replacement in children: A systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2016, 151(1): 143-152.
42. Buratto E, Wallace F, Schulz A, et al. The Ross procedure in children: Defining the optimal age. Heart Lung Circ, 2023, 32(6): 745-749.
43. Sharabiani MT, Dorobantu DM, Mahani AS, et al. Aortic valve replacement and the Ross operation in children and young adults. J Am Coll Cardiol, 2016, 67(24): 2858-2870.
44. Zarate YA, Sellars E, Lepard T, et al. Aortic dilation in pediatric patients. Eur J Pediatr, 2015, 174(12): 1585-1592.
45. Mariucci E, Donti A, Guidarini M, et al. Diagnostic accuracy of aortic root cross-sectional area/height ratio in children and young adults with Marfan and Loeys-Dietz syndrome. Congenit Heart Dis, 2016, 11(3): 276-282.
46. Siurana JM, Sabaté-Rotés A, Ayerza A, et al. Adolescents with bicuspid aortic valve: Which criteria should we use for aortic dilatation? Int J Cardiol, 2021, 333: 90-93.
47. Rodriguez M, Malvea A, McNally D, et al. Aortic valve intervention during aortic root surgery in children: A systematic review. World J Pediatr Congenit Heart Surg, 2020, 11(5): 611-618.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Chinese expert consensus on surgical treatment of aortic valve disease in children

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content