Aortic valve replacement with concomitant aortoventriculoplasty in children and young adults: long-term follow-up

Sixteen patients (9 male, 7 female) underwent aortic valve replacement (AVR) with a Konno aortoventriculoplasty at the University of Nebraska Medical Center from August, 1976, to May, 1986. There was 1 early death (6%), but no operative deaths have occurred since 1977. There was 1 late death from unknown cause 51 months postoperatively. One patient has been lost to follow-up. Long-term follow-up of 14 patients was 923 months (mean, 66 months; range, 9 to 120 months). Of the 16 patients, 12 (75%) had had previous cardiovascular procedures. A total of thirty-five operations, including the aortoventriculoplasties, were done in the 16 patients. Of the aortic valves inserted, 11 were tissue valves (Carpentier-Edwards, 10; Ionescu-Shiley, 1) and 5 were mechanical valves (St. Jude, 3; Björk-Shiley, 2). Patient age at the time of aortoventriculoplasty ranged from 2 years 3 months to 24 years (median, 11 years 8 months). Size of the aortic annulus ranged from 10 to less than 21 mm (median, 16 mm). Valves inserted ranged from 21 to 29 mm; 13 (81%) of them were 25 mm or larger. In 2 patients, degenerated tissue valves were replaced with mechanical valves after 110 and 33 months. At present, all patients are in New York Heart Association Functional Class I. One female patient married and delivered a normal child approximately five years after AVR with a Carpentier-Edwards valve plus aortoventriculoplasty; she never received anticoagulant medications. We conclude that AVR with a concomitant Konno aortoventriculoplasty can be safely performed in the pediatric and young-adult age groups with satisfactory results for up to ten years.