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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Valve-sparing aortic root replacement in children: intermediate-term results.

Nishant D Patel1, George J Arnaoutakis, Timothy J George

  • 1Johns Hopkins Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.

Interactive Cardiovascular and Thoracic Surgery
|December 2, 2010
PubMed
Summary

Valve-sparing root replacement (VSRR) is safe for children with aortic aneurysms. Reimplantation techniques are superior to remodeling for preventing late aortic insufficiency in patients with connective tissue disorders.

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Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Genetics

Background:

  • Aortic root aneurysm in children often necessitates surgical intervention.
  • Long-term outcomes of valve-sparing root replacement (VSRR) in pediatric patients remain incompletely understood.
  • Connective tissue disorders like Marfan and Loeys-Dietz syndromes are common indications for VSRR in children.

Purpose of the Study:

  • To evaluate the mid- and late-term safety and efficacy of VSRR in a pediatric cohort.
  • To compare the outcomes of different VSRR techniques, specifically reimplantation versus remodeling.
  • To assess the incidence of aortic insufficiency and need for reoperation after VSRR in children.

Main Methods:

  • Retrospective review of 56 children undergoing VSRR between 1997 and 2009.
  • Analysis of patient demographics, diagnoses (Marfan, Loeys-Dietz syndromes), preoperative aortic dimensions, and surgical techniques (David I, Yacoub remodeling, Valsalva-graft reimplantation).
  • Assessment of operative mortality, late mortality, reoperations, thromboembolic events, endocarditis, and development of significant aortic insufficiency (>2+ AI) during a mean follow-up of 5.2 years.

Main Results:

  • Overall operative mortality was 1.8% and late mortality was 5.4%.
  • No thromboembolic events or endocarditis were observed.
  • While 33.3% of patients undergoing remodeling developed >2+ AI requiring further intervention, no patients undergoing reimplantation developed significant AI.
  • Reimplantation techniques (David I, Valsalva-graft) demonstrated superior outcomes in preventing late AI compared to remodeling.

Conclusions:

  • VSRR is a safe and effective alternative to prosthetic aortic root replacement in children.
  • For pediatric patients with connective tissue disorders, VSRR with reimplantation techniques is preferable to remodeling due to a lower incidence of late aortic insufficiency.
  • VSRR offers a viable option for managing aortic aneurysms in children, preserving native valve function effectively.