Aortic valve replacement with biological substitutes in children.

Area of Science:

• Pediatric Cardiac Surgery
• Cardiovascular Surgery
• Biomaterials in Medicine

Background:

• Aortic valve disease in children necessitates surgical intervention.
• Biological substitutes offer alternatives to mechanical valves in pediatric patients.
• Homografts, pulmonary autografts (Ross procedure), and autologous pericardium (Duran technique) are key biological options.

Purpose of the Study:

• To evaluate the outcomes of aortic valve replacement in children using various biological substitutes.
• To assess the hemodynamic performance and long-term results of these valve replacements.
• To compare the efficacy of homografts, Ross procedure, and Duran technique in pediatric aortic valve surgery.

Main Methods:

• A cohort of 73 children with aortic valve disease underwent aortic valve replacement with biological substitutes between March 1992 and July 2009.
• Procedures included homografts, pulmonary autografts (Ross procedure), and aortic valve reconstruction with autologous pericardium (Duran technique).
• Associated procedures like mitral valve repair and subaortic membrane resection were also performed.

Main Results:

• Early mortality was low at 1.4%.
• At a median follow-up of 94 months, 83.3% of survivors had insignificant aortic regurgitation.
• Reoperation was required in 9.6% of patients due to various complications, including graft dysfunction and obstruction. Actuarial reoperation-free survival was 92.5% ±4% at 94 months.

Conclusions:

• Aortic valve replacement in children using biological substitutes yields acceptable midterm hemodynamic results.
• The study supports the use of homografts, Ross procedure, and Duran technique in pediatric aortic valve replacement.
• Biological substitutes provide a viable option for managing aortic valve disease in pediatric populations.