title: Surgery for aortic root aneurysm in children: a 21-year experience in 50 patients.
abstract: BACKGROUND
  Ascending aortic aneurysms are unusual in children and have received little attention to develop guidelines for management. This study reviewed our experience with 50 children who have undergone aortic root replacement for ascending aortic aneurysm.
  
  
  METHODS
  A retrospective clinical review was conducted using hospital charts and office records. Patients or their physicians were contacted for follow-up and recent echocardiograms were obtained and reviewed.
  
  
  RESULTS
  There was no operative or hospital mortality. Twenty-six children had aortic root replacement with a composite graft, 10 patients had replacement with a homograft aortic root, and 14 patients had a David II valve-sparing procedure. Factors related to late morbidity and mortality were analyzed. Long-term results were excellent in the 26 children receiving a composite graft. Twenty-three of these children were New York Heart Association class I (19) or II (4) at study closure. There were 3 late deaths (11, 16, and 17 years postoperative). Seven of 10 children receiving a homograft aortic root are long-term survivors and all 14 children having a valve-sparing procedure are alive. Generally, late results with the David II remodeling procedure have been good although 3 patients developed late aortic insufficiency and two required valve replacement.
  
  
  CONCLUSIONS
  Aortic root replacement in children with aneurysms has low operative risk and good long-term results. Composite grafts in particular carry a low risk of endocarditis, thromboembolism, and hemorrhagic events. Homografts are suitable for small patients but lack durability. Late results with the David II remodeling valve-sparing procedure in children have been compromised by late root dilatation.
authors.affiliation: Division of Cardiac Surgery, Howard Hughes Medical Institute, Baltimore, MD 21287, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cattaneo
authors.forename: Brian T
authors.initials: BT
authors.lastname: Bethea
authors.forename: Diane E
authors.initials: DE
authors.lastname: Alejo
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Spevak
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Clauss
authors.forename: Harry C
authors.initials: HC
authors.lastname: Dietz
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Gott
authors.forename: Duke E
authors.initials: DE
authors.lastname: Cameron
mesh_terms: D000293:Adolescent; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors