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Biological versus mechanical aortic valve replacement in children
M W Turrentine1, M Ruzmetov, P Vijay
1Section of Cardiothoracic Surgery, James W. Riley Hospital for Children, and Indiana University School of Medicine, Indianapolis 46202-5123, USA. mturren@iupui.edu
The Annals of Thoracic Surgery
|June 5, 2001
Summary
Pediatric aortic valve replacement using the Ross procedure (pulmonary autograft) shows promising long-term results and avoids anticoagulation. This study compares it with other prosthetic devices over 27 years.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Pediatric aortic valve replacement presents challenges due to limited prosthetic options.
- Anticoagulation risks with mechanical valves and degeneration of biological substitutes drive interest in the Ross procedure.
Purpose of the Study:
- To evaluate the 27-year experience with various prosthetic devices for aortic valve replacement in children.
- To compare the outcomes of the Ross procedure (pulmonary autograft) against mechanical valves, aortic homografts, and xenografts.
Main Methods:
- A retrospective study of 99 pediatric patients undergoing aortic valve replacement between 1973 and 2000.
- Procedures included pulmonary autograft (PA, n=42), aortic homograft (AH, n=3), mechanical valves (MV, n=41), and xenograft tissue valves (XG, n=13).
Main Results:
- The pulmonary autograft group showed a significantly lower incidence of valve-related complications and reoperations (11.9%) compared to mechanical valves (15.2%), xenografts (70%), and aortic homografts (50%).
- Perioperative outcomes and early deaths were similar across all groups.
- Actuarial survival rates at 10 years were 87.8% for MV and 100% for XG, while at 7 years, they were 95.2% for PA and 6.6% for AH.
Conclusions:
- Aortic valve replacement in children can achieve acceptable mortality and good long-term outcomes.
- The Ross procedure offers advantages including no need for anticoagulation, suitability for all age groups, growth potential, and favorable left ventricular outflow tract hemodynamics, despite its complexity.