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Aortic valve replacement in pediatric patients: 30 years single center experience
Johanna Schlein1, Paul Simon1, Gregor Wollenek1
1University Clinic of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Insights
Mechanical aortic valve replacement (AVR) shows lower re-operation rates compared to biological AVR, but carries significant risks of thromboembolic and bleeding events. Patient choice requires careful interdisciplinary discussion of long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Clinical Outcomes Research
Background:
- Aortic valve replacement (AVR) decisions require interdisciplinary input, considering re-operation needs and anticoagulation risks.
- Long-term outcomes of different AVR strategies are crucial for patient management.
Purpose of the Study:
- To compare long-term outcomes between mechanical AVR and biological AVR.
- To evaluate re-operation rates and associated risks in pediatric AVR patients.
Main Methods:
- Retrospective chart review of patients under 18 years old who underwent AVR between May 1985 and April 2020.
- Comparison of study endpoints between mechanical AVR and biological AVR cohorts, including review of contraindications for the Ross procedure.
Main Results:
- Fifty-five patients received sixty AVRs (33 mechanical, 27 biological).
- Freedom from aortic valve re-operation at 10 years was significantly higher for mechanical AVR (95.2%) than biological AVR (33.6%).
- Early mortality was 5%, exclusively in patients younger than 1 year; 30-year survival was 86.4% ± 6.2%.
Conclusions:
- Mechanical AVR demonstrated a lower frequency of re-operation compared to biological AVR.
- Mechanical AVR is associated with a considerable risk of thromboembolic and bleeding events (3.2% per valve-year).
Background:
The choice of aortic valve replacement needs to be decided in an interdisciplinary approach and together with the patients and their families regarding the need for re-operation and risks accompanying anticoagulation. We report long-term outcomes after different AVR options.
Methods:
A chart review of patients aged < 18 years at time of surgery, who had undergone AVR from May 1985 until April 2020 was conducted. Contraindications for Ross procedure, which is performed since 1991 at the center were reviewed in the observed non-Ross AVR cohort. The study endpoints were compared between the mechanical AVR and the biological AVR cohort.
Results:
From May 1985 to April 2020 fifty-five patients received sixty AVRs: 33 mechanical AVRs and 27 biological AVRs. In over half of the fifty-three AVRs performed after 1991 (58.5%; 31/53) a contraindication for Ross procedure was present. Early mortality was 5% (3/60). All early deaths occurred in patients aged < 1 year at time of surgery. Two late deaths occurred and survival was 94.5% ± 3.1% at 10 years and 86.4% ± 6.2% at 30 years. Freedom from aortic valve re-operation was higher (p < 0.001) in the mechanical AVR than in the biological AVR cohort with 95.2% ± 4.6% and 33.6% ± 13.4% freedom from re-operation at 10 years respectively.
Conclusions:
Re-operation was less frequent in the mechanical AVR cohort than in the biological AVR cohort. For mechanical AVR, the risk for thromboembolic and bleeding events was considerable with a composite linearized event rate per valve-year of 3.2%.
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