Valve-sparing aortic root replacement in children: intermediate-term results.
Valve-sparing root replacement (VSRR) is an attractive option for aortic aneurysm in children with low-operative risk, but mid- and late-term results are not yet known. Between 1997 and 2009, 56 children (mean age 11.5 years) underwent VSRR at our institution. Twenty-six (46.4%) had Marfan syndrome and 24 (42.8%) had Loeys-Dietz syndrome. Mean preoperative max sinus diameter was 4.2±0.8 cm (Z-score 7.7±2.9). Five (8.9%) had >2+ aortic insufficiency (AI). Two (3.6%) underwent David I reimplantation with a straight-tube, 12 (21.4%) had a Yacoub remodeling procedure, and 42 (75.0%) had reimplantation using a Valsalva-graft. There were one (1.8%) operative and three (5.4%) late deaths. One patient required reoperation for bleeding and one required late repair of a distal pseudoaneurysm. Mean follow-up was 5.2 years (range 0-12 years). No patients suffered thromboembolic events or had endocarditis. Of the 12 remodeling patients, four (33.3%) developed >2+ AI and required aortic valve repair or replacement. No patient developed >2+ AI after reimplantation. VSRR in children is a safe alternative to aortic root replacement with mechanical or biological prostheses. In this particular group of patients with connective tissue disorders and proclivity toward annular dilation and late AI, reimplantation is superior to remodeling.
Johns Hopkins Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Nishant D
ND
Patel
George J
GJ
Arnaoutakis
Timothy J
TJ
George
Jeremiah G
JG
Allen
Diane E
DE
Alejo
Harry C
HC
Dietz
Duke E
DE
Cameron
Luca A
LA
Vricella
D000293:Adolescent; D001014:Aortic Aneurysm / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D015142:Baltimore; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D055947:Loeys-Dietz Syndrome / Q000150:complications* / Q000401:mortality / Q000601:surgery; D008297:Male; D008382:Marfan Syndrome / Q000150:complications* / Q000401:mortality / Q000601:surgery; D018579:Patient Selection; D012086:Reoperation; D012092:Replantation / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome