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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Surgery for aortic root aneurysm in children: a 21-year experience in 50 patients
Stephen M Cattaneo1, Brian T Bethea, Diane E Alejo
1Division of Cardiac Surgery, Howard Hughes Medical Institute, Baltimore, MD 21287, USA.
Insights
Pediatric ascending aortic aneurysms are rare. Aortic root replacement offers good long-term results, with composite grafts showing excellent outcomes and low complication risks in children.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Aortic Aneurysm Research
Background:
- Ascending aortic aneurysms are uncommon in pediatric patients.
- Limited guidelines exist for managing pediatric ascending aortic aneurysms.
- This study addresses the management of 50 children with ascending aortic aneurysms.
Purpose of the Study:
- To review the clinical experience with aortic root replacement in children with ascending aortic aneurysms.
- To evaluate the long-term outcomes and identify factors influencing morbidity and mortality.
Main Methods:
- Retrospective review of hospital charts and office records.
- Patient or physician contact for follow-up information.
- Review of recent echocardiograms for assessment.
Main Results:
- No operative or hospital mortality observed.
- Composite grafts (n=26) showed excellent long-term results with NYHA class I/II function.
- Homografts (n=10) and David II valve-sparing procedures (n=14) had varying degrees of success, with some late complications noted.
Conclusions:
- Aortic root replacement in children with aneurysms is associated with low operative risk and favorable long-term outcomes.
- Composite grafts demonstrate a low risk of endocarditis, thromboembolism, and bleeding.
- Homografts are suitable for smaller patients but have durability issues; David II procedure results are good but can be affected by late root dilatation.
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.
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