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Aortic Valve Surgery in Children With Infective Endocarditis

Damien M Wu1, Michael Z L Zhu1, Edward Buratto1

  • 1Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.

Seminars in Thoracic and Cardiovascular Surgery
|March 10, 2023
PubMed

Insights

Surgery for pediatric aortic valve infective endocarditis (IE) shows good survival, but reoperation is common. The Ross procedure is often the best surgical option when valve repair isn't possible.

Area of Science:

  • Pediatric cardiology
  • Cardiac surgery
  • Infective endocarditis research

Background:

  • Limited data exists on long-term outcomes for children with aortic valve infective endocarditis (IE).
  • The optimal surgical strategy for pediatric aortic valve IE remains debated.

Purpose of the Study:

  • To investigate the long-term outcomes of surgical interventions for aortic valve IE in children.
  • To evaluate the efficacy of the Ross procedure compared to other surgical options.

Main Methods:

  • Retrospective review of 41 children undergoing surgery for aortic valve IE between 1989 and 2020.
  • Surgical approaches included valve repair, Ross procedure, homograft root replacement, and mechanical valve replacement.
  • Analysis of operative mortality, long-term survival, and freedom from reoperation.

Main Results:

  • Operative mortality varied: 0% for repair, 15.4% for Ross, 33.3% for homograft, and 33.3% for mechanical replacement.
  • Ten-year survival rates were 87.5% (repair), 74.1% (Ross), and 66.7% (homograft).
  • Ten-year freedom from reoperation was significantly higher for the Ross procedure (63.0%) compared to homograft (26.3%).

Conclusions:

  • Pediatric patients with aortic valve IE demonstrate acceptable long-term survival post-surgery.
  • A significant need for reintervention exists, highlighting the importance of durable surgical solutions.
  • The Ross procedure emerges as a potentially optimal choice when aortic valve repair is not feasible.

Keywords:
Aortic valveAutograftEndocarditisHomograftMechanicalRepairRoss

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