title: Mechanical aortic valve replacement in children and adolescents after previous repair of congenital heart disease.
abstract: Due to improved outcome after surgery for congenital heart defects, children, adolescents, and grown-ups with congenital heart defects become an increasing population. In order to evaluate operative risk and early outcome after mechanical aortic valve replacement (AVR) in this population, we reviewed patients who underwent previous repair of congenital heart defects. Between July 2002 and November 2008, 15 (10 male and 5 female) consecutive patients (mean age 14.5 +/- 10.5 years) underwent mechanical AVR. Hemodynamic indications for AVR were aortic stenosis in four (27%), aortic insufficiency in eight (53%), and mixed disease in three (20%) after previous repair of congenital heart defects. All patients had undergone one or more previous cardiovascular operations due to any congenital heart disease. Concomitant cardiac procedures were performed in all of them. In addition to AVR, in two patients, a mitral valve exchange was performed. One patient received a right ventricle-pulmonary artery conduit replacement as concomitant procedure. The mean size of implanted valves was 23 mm (range 17-29 mm). There were neither early deaths nor late mortality until December 2008. Reoperations were necessary in five (33%) and included implantation of a permanent pacemaker due to complete atrioventricular block in two (15%), mitral valve replacement with a mechanical prosthesis due to moderate to severe mitral regurgitation in one (7%), aortocoronary bypass grafting due to stenosis of a coronary artery in one (7%), and in one (7%), a redo subaortic stenosis resection was performed because of a secondary subaortic stenosis. At the latest clinical evaluation, all patients were in good clinical condition without a pathological increased gradient across the aortic valve prosthesis or paravalvular leakage in echocardiography. Mechanical AVR has excellent results in patients after previous repair of congenital heart defects in childhood, even in combination with complex concomitant procedures. Previous operations do not significantly affect postoperative outcome.
authors.affiliation: Department of Thoracic Cardiovascular Surgery, University of Göttingen, Göttingen, Germany. popov@med.uni-goettingen.de
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
authors.forename: Kasim Oguz
authors.initials: KO
authors.lastname: Coskun
authors.forename: Theodor
authors.initials: T
authors.lastname: Tirilomis
authors.forename: Jan Dieter
authors.initials: JD
authors.lastname: Schmitto
authors.forename: José
authors.initials: J
authors.lastname: Hinz
authors.forename: Thomas
authors.initials: T
authors.lastname: Kriebel
authors.forename: Friedrich Albert
authors.initials: FA
authors.lastname: Schoendube
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ruschewski
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult