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Redo aortic valve replacement in children

Kirk R Kanter1, Paul M Kirshbom, Brian E Kogon

  • 1Division of Cardio-Thoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA. kkanter@emory.edu

The Annals of Thoracic Surgery
|October 26, 2006
PubMed

Insights

Redo aortic valve replacement (AVR) in children is feasible with acceptable outcomes, though repeat reoperations increase risk. Early referral is crucial to prevent ventricular dysfunction and improve results for pediatric cardiac surgery patients.

Area of Science:

  • Pediatric Cardiac Surgery
  • Congenital Heart Disease Management
  • Cardiovascular Therapeutics

Background:

  • A subset of children undergoing aortic valve replacement (AVR) require subsequent valve re-replacement (redo-AVR).
  • This study analyzes outcomes from 38 redo-AVRs performed on 30 pediatric patients.

Purpose of the Study:

  • To evaluate the safety and efficacy of redo-AVR in a pediatric population.
  • To identify factors influencing outcomes in children requiring repeat aortic valve surgery.

Main Methods:

  • Retrospective analysis of 38 redo-AVRs in 30 children (age 2 months–20 years).
  • Indications included stenosis, regurgitation, endocarditis, thrombosis, and aneurysm.
  • Surgical techniques involved prosthesis implantation, often with annulus enlargement (Konno, Manougian procedures).

Main Results:

  • Most redo-AVRs used mechanical prostheses; 71% involved annulus enlargement.
  • Upsizing the valve prosthesis was common (25 valves, median increase 4 mm).
  • Hospital mortality was higher in second or third redo-AVRs; the only death in first redo-AVR patients was in cardiogenic shock.

Conclusions:

  • Redo-AVR in children can be achieved with manageable morbidity and mortality.
  • Larger valve prostheses can be successfully implanted during redo-AVR.
  • Second or third redo-AVRs carry higher risks, underscoring the need for early referral before ventricular dysfunction develops.
Abstract

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