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Aortic valve-sparing procedure in the pediatric population

Yves d'Udekem1, Eiri Kisamori1, Shuta Ishigami2

  • 1Division of Cardiovascular Surgery, Children's National Heart Institute, Children's National Hospital, Washington, DC, USA.

Annals of Cardiothoracic Surgery
|June 12, 2023
PubMed

Insights

Aortic valve-sparing surgery is feasible in children with aortic root aneurysms, though complex. This pediatric study shows successful outcomes with the David procedure, but highlights the need for surgical expertise.

Area of Science:

  • Pediatric Cardiac Surgery
  • Aortic Valve Repair
  • Aortic Root Aneurysm Management

Background:

  • Aortic valve-sparing procedures are standard for adults with aortic root aneurysms.
  • Limited data exists on pediatric application of these valve-sparing techniques.
  • This study addresses the use of aortic valve-sparing procedures in children.

Purpose of the Study:

  • To evaluate the safety and efficacy of aortic valve-sparing procedures in pediatric patients.
  • To report outcomes of aortic valve-sparing surgery in a pediatric cohort.

Main Methods:

  • Retrospective review of pediatric patients undergoing aortic valve-sparing procedures.
  • Data collected from April 2006 to April 2016 at a single institution.
  • Analysis of clinical and echocardiographic data.

Main Results:

  • Seventeen pediatric patients (median age 15.7 years) underwent the David procedure.
  • Common diagnoses included transposition of great arteries, Loeys-Dietz, and Marfan syndromes.
  • High rates of preoperative aortic regurgitation (94.1%) were noted. Freedom from reoperation at 10 years was 68.2%.

Conclusions:

  • Aortic valve-sparing surgery can be successfully performed in pediatric patients.
  • The procedure demands significant surgical skill due to complex valve anatomy.
  • Additional leaflet procedures may be necessary for optimal outcomes.
Abstract

Keywords:
Loeys-Dietz syndromeMarfan syndromeValve-sparing aortic root replacementcongenital heart surgerypediatrics

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