title: Systemic Semilunar Valve Replacement in Pediatric Patients Using a Porcine, Full-Root Bioprosthesis.
abstract: BACKGROUND
  Management of systemic semilunar valve disease in growing, young patients is challenging. When replacement is necessary, use of a pulmonary autograft is sometimes not possible for anatomic, pathologic, or technical reasons or due to parental or patient preference. We employed a stentless, porcine, full-root bioprosthesis in this setting and report our outcomes.
  
  
  METHODS
  Over 9 years (2005 to 2013), 24 patients of mean age 13.1 years (range, 3 months to 20.3 years) underwent operation for mixed stenosis and insufficiency in 16 of 24 (67%), pure insufficiency in 7 of 24 (29%), and pure stenosis in 1 of 24 (4%). Twenty patients had previous interventions of repair or replacement, valvuloplasty, or multiple operations. Survival, follow-up echocardiographic findings, and outcomes were documented. All patients were maintained on daily aspirin.
  
  
  RESULTS
  There were no hospital deaths and no early or late deaths over a mean follow-up for 23 patients of 46.1 months (range, 14 months to 9.2 years). One patient moved abroad and was lost to follow-up. Echocardiographic follow-up (mean 34.0 months) demonstrated that no patient developed more than mild insufficiency or moderate stenosis. In total, 20 of 24 (83%) showed no insufficiency and 11 of 24 patients (46%) showed no stenosis. Near or complete normalization of left ventricular mass and dimension was demonstrated. There were no explants and no thromboembolic or bleeding events.
  
  
  CONCLUSIONS
  When use of a pulmonary autograft is not an option, the porcine full-root bioprosthesis appears favorable for systemic semilunar valve replacement in the pediatric and young adult population. Of note, when prosthetic degeneration does occur, stenosis predominates rather than insufficiency. Longer term studies are warranted.
authors.affiliation: Division of Cardiothoracic Surgery, The Children's Heart Center, The University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Bhawna
authors.initials: B
authors.lastname: Gupta
authors.affiliation: Division of Cardiothoracic Surgery, The Children's Heart Center, The University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Ali
authors.initials: A
authors.lastname: Dodge-Khatami
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Fraser
authors.affiliation: Department of Cardiothoracic Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors.forename: John H
authors.initials: JH
authors.lastname: Calhoon
authors.affiliation: Division of Pediatric Cardiology, The Children's Heart Center, The University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Makram R
authors.initials: MR
authors.lastname: Ebeid
authors.affiliation: Division of Pediatric Critical Care, The Children's Heart Center, The University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Taylor
authors.affiliation: Division of Cardiothoracic Surgery, The Children's Heart Center, The University of Mississippi Medical Center, Jackson, Mississippi. Electronic address: jsalazar@umc.edu.
authors.forename: Jorge D
authors.initials: JD
authors.lastname: Salazar
mesh_terms: D000293:Adolescent; D000818:Animals; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D007223:Infant; D008297:Male; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000601:surgery*; D012092:Replantation; D012189:Retrospective Studies; D013552:Swine; D055815:Young Adult