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OBJECTIVE:
We reviewed our experience with aortic valve-sparing operations in pediatric patients during last 15 years.
METHODS:
Between September 1996 and June 2011, 21 pediatric patients with aortic root aneurysms underwent valve-sparing operations. Of these, 6 patients (29%) previously underwent a Ross procedure, 5 (23%) were diagnosed with Marfan syndrome, and remaining 10 patients (48%) had different types of congenital pathologies. Mean age was 15.2±3.7 years (range, 4 to 18 years). Moderate/severe aortic insufficiency (AI) was present in 38% (8/21), and the mean diameter of the Valsalva sinuses was 48.3±4.1mm (range, 40 to 55mm). The David II remodeling procedure was performed in all patients. Additional procedures were aortic valvuloplasty in 8, right ventricular outflow tract reconstruction with conduit in 3, mitral valve repair in 1, subaortic membrane resection in 1, and pectus excavatum repair in 1.
RESULTS:
There were no in-hospital or late deaths and no major adverse outcomes. Five patients developed significant late AI and all required aortic valve replacement (AVR). Freedom from late AVR was 86% at 3 and 76% at 7 years. Preoperative significant AI (p=0.39) and previous Ross procedure (p=0.34) were not a significant risk factors for late AVR. In the last follow-up (mean, 5.6±4.3 years; range, 1 month to 14 years), 9 patients did not have AI, and 7 had mild regurgitation. There were no episodes of endocarditis or clinically significant thromboembolism, and 100% of the patients are free from anticoagulation.
CONCLUSIONS:
Remodeling technique repair of the aortic root and/or ascending aorta in children and adolescent patients can be performed with acceptable early and late results. Composite grafts in particular carry a low risk of endocarditis, thromboembolism, and hemorrhagic events. Valve-sparing procedures promise excellent quality of life by avoiding anticoagulation, but will need further refinement to match the high standards set by composite grafts.