{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:28:22Z","timestamp":1791390502875,"version":"4.3.3"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T00:00:00Z","timestamp":1601510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p\/>\n                    <jats:p>Aortic stenosis or regurgitation that requires operations in children often results from unicuspid valve morphology. In all paediatric patients with this anomaly, we have performed unicuspid valve repair by bicuspidization, creating a new commissure via adding patch material. This study reviewed our experience with this procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>All patients with a unicuspid aortic valve who underwent bicuspidization at \u226418\u2009years of age between 2003 and 2018 were evaluated. Autologous pericardium had initially been used for cusp augmentation. Since 2014, decellularized xenogeneic tissue or expanded polytetrafluoroethylene membrane has been applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>There were 60 consecutive patients. The median operative age was 13 (1\u201318) years. Thirty patients had prior surgical or catheter valvuloplasties. Aortic regurgitation, aortic stenosis and their combination were present in 22, 11 and 27 patients, respectively. Autologous pericardium decellularized tissue and expanded polytetrafluoroethylene were used in 45, 11 and 4 patients, respectively, without intraoperative conversion to valve replacement. The overall survival was 96% at 10\u2009years with 2 late deaths. Twenty patients underwent aortic valve reoperation due to patch degeneration (n\u2009=\u200911), suture dehiscence of the patch (n\u2009=\u20093), subaortic stenosis (n\u2009=\u20093) or other reasons (n\u2009=\u20093). Freedom from aortic valve reoperation was 73% and 50% at 5 and 10\u2009years, respectively. Fifteen patients (25%) required valve replacement with pulmonary autograft (n\u2009=\u200914) or prosthesis (n\u2009=\u20091) 5.2 (0.2\u201313) years after bicuspidization at the age of 19 (10\u201332) years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Bicuspidization is a safe and reproducible alternative to valve replacement with acceptable freedom from reoperation. It can serve as a bridge to valve replacement providing superior outcomes in adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa285","type":"journal-article","created":{"date-parts":[[2020,7,8]],"date-time":"2020-07-08T15:09:53Z","timestamp":1594220993000},"page":"253-261","source":"Crossref","is-referenced-by-count":31,"title":["Unicuspid aortic valve repair with bicuspidization in the paediatric population"],"prefix":"10.1093","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9415-5788","authenticated-orcid":false,"given":"Shunsuke","family":"Matsushima","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg\/Saar, German"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"He\u00df","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg\/Saar, German"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia Renata","family":"L\u00e4mmerzahl","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg\/Saar, German"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7208-1343","authenticated-orcid":false,"given":"Irem","family":"Karliova","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg\/Saar, German"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hashim","family":"Abdul-Khaliq","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Saarland University Medical Center, Homburg\/Saar, German"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Joachim","family":"Sch\u00e4fers","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg\/Saar, German"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,10,1]]},"reference":[{"key":"2021010414504337800_ezaa285-B1","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/0002-9149(78)90635-5","article-title":"Congenital heart disease in a cohort of 19,502 births with long-term follow-up","volume":"42","author":"Hoffman","year":"1978","journal-title":"Am J Cardiol"},{"key":"2021010414504337800_ezaa285-B2","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.jtcvs.2012.11.033","article-title":"Long-term results of a strategy of aortic valve repair in the pediatric population","volume":"145","author":"d'Udekem","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021010414504337800_ezaa285-B3","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1093\/ejcts\/ezx172","article-title":"Contemporary results of aortic valve repair for congenital disease: lessons for management and staged strategy","volume":"52","author":"Vergnat","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021010414504337800_ezaa285-B4","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.jtcvs.2018.08.089","article-title":"Aortic stenosis of the neonate: a single-center experience","volume":"157","author":"Vergnat","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021010414504337800_ezaa285-B5","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1093\/ejcts\/ezy069","article-title":"The great debate series: surgical treatment of aortic valve abnormalities in children","volume":"53","author":"d\u2019Udekem","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021010414504337800_ezaa285-B6","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s12055-019-00813-2","article-title":"Geometry of cusp and root determines aortic valve function","volume":"36","author":"Matsushima","year":"2020","journal-title":"Indian J Thorac Cardiovasc Surg"},{"key":"2021010414504337800_ezaa285-B7","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/S0022-5223(19)34800-7","article-title":"Morphology of the ventriculoaortic junction in critical aortic stenosis. Implications for hemodynamic function and clinical management","volume":"104","author":"McKay","year":"1992","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021010414504337800_ezaa285-B8","first-page":"670","article-title":"Understanding the structure of the unicuspid and unicommissural aortic valve","volume":"12","author":"Anderson","year":"2003","journal-title":"J Heart Valve Dis"},{"key":"2021010414504337800_ezaa285-B9","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1053\/j.pcsu.2012.01.004","article-title":"Aortic valve reconstruction in the young infants and children","volume":"15","author":"Baird","year":"2012","journal-title":"Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu"},{"key":"2021010414504337800_ezaa285-B10","doi-asserted-by":"crossref","first-page":"2175","DOI":"10.1016\/j.athoracsur.2013.07.130","article-title":"Outcomes after operations for bicuspid aortic valve disease in the pediatric population","volume":"96","author":"Siddiqui","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2021010414504337800_ezaa285-B11","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1016\/j.jtcvs.2007.01.039","article-title":"A classification system for the bicuspid aortic valve from 304 surgical specimens","volume":"133","author":"Sievers","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021010414504337800_ezaa285-B12","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1161\/01.CIR.0000155623.48408.C5","article-title":"Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation","volume":"111","author":"Roberts","year":"2005","journal-title":"Circulation"},{"key":"2021010414504337800_ezaa285-B13","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1016\/j.athoracsur.2008.02.081","article-title":"Bicuspidization of the unicuspid aortic valve: a new reconstructive approach","volume":"85","author":"Sch\u00e4fers","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"2021010414504337800_ezaa285-B14","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/j.athoracsur.2013.02.030","article-title":"Aortic valve function after bicuspidization of the unicuspid aortic valve","volume":"95","author":"Aicher","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2021010414504337800_ezaa285-B15","doi-asserted-by":"crossref","first-page":"430","DOI":"10.21037\/acs.2019.05.04","article-title":"Unicuspid valve repair-what technique, which patch for which patient?","volume":"8","author":"Matsushima","year":"2019","journal-title":"Ann Cardiothorac Surg"},{"key":"2021010414504337800_ezaa285-B16","first-page":"111","article-title":"Bicuspidization and annuloplasty provide a functioning configuration to the unicuspid aortic valve","volume-title":"Ann Thorac Surg","author":"Igarashi","year":"2020"},{"key":"2021010414504337800_ezaa285-B17","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.jtcvs.2006.04.032","article-title":"A new approach to the assessment of aortic cusp geometry","volume":"132","author":"Sch\u00e4fers","year":"2006","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021010414504337800_ezaa285-B18","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jtcvs.2012.06.053","article-title":"Cusp height in aortic valves","volume":"146","author":"Sch\u00e4fers","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021010414504337800_ezaa285-B19","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.1093\/eurheartj\/ehx391","article-title":"2017 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"38","author":"Baumgartner","year":"2017","journal-title":"Eur Heart J"},{"key":"2021010414504337800_ezaa285-B20","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/j.echo.2008.02.006","article-title":"Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study","volume":"21","author":"Pettersen","year":"2008","journal-title":"J Am Soc Echocardiogr"},{"key":"2021010414504337800_ezaa285-B21","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1093\/ejechocard\/jeq030","article-title":"European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease)","volume":"11","author":"Lancellotti","year":"2010","journal-title":"Eur J Echocardiogr"},{"key":"2021010414504337800_ezaa285-B22","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1093\/ehjci\/jex344","article-title":"Echocardiographic criteria to detect unicuspid aortic valve morphology","volume":"20","author":"Ewen","year":"2019","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2021010414504337800_ezaa285-B23","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1016\/j.athoracsur.2017.12.031","article-title":"Aortic valve repair of a stenoticunicuspid aortic valve in young patients","volume":"105","author":"Kolesar","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"2021010414504337800_ezaa285-B24","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.jtcvs.2015.09.083","article-title":"Outcome after aortic valve replacement in children: a systematic review and meta-analysis","volume":"151","author":"Etnel","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021010414504337800_ezaa285-B25","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1093\/ejcts\/ezx456","article-title":"Free margin length and coaptation surface area in normal tricuspid aortic valve: an anatomical study","volume":"53","author":"De Kerchove","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021010414504337800_ezaa285-B26","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.jtcvs.2014.05.041","article-title":"Aortic valve reconstruction using autologous pericardium for patients aged less than 60 years","volume":"148","author":"Ozaki","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021010414504337800_ezaa285-B27","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1093\/ejcts\/ezy181","article-title":"Results of aortic valve repair using decellularized bovine pericardium in congenital surgery","volume":"54","author":"Nordmeyer","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021010414504337800_ezaa285-B28","doi-asserted-by":"crossref","first-page":"e361","DOI":"10.1016\/j.athoracsur.2018.11.048","article-title":"Suture annuloplasty and simplified root wrapping in the full root Ross operation","volume":"107","author":"Matsushima","year":"2019","journal-title":"Ann Thorac Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/59\/1\/253\/35388683\/ezaa285.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/59\/1\/253\/35388683\/ezaa285.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T14:53:36Z","timestamp":1609772016000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/59\/1\/253\/5916386"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,1]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,10,1]]},"published-print":{"date-parts":[[2021,1,4]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaa285","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,1]]},"published":{"date-parts":[[2020,10,1]]}}}