Midterm to Long-term Outcomes After Aortic Valve Replacement With Homograft in Children

Area of Science:

• Pediatric Cardiology
• Cardiovascular Surgery
• Biomaterials in Medicine

Background:

• Aortic valve disease in children necessitates surgical intervention.
• Aortic homograft root replacement serves as an alternative to mechanical valves or the Ross procedure.
• Evaluating long-term outcomes is crucial for pediatric aortic valve disease management.

Purpose of the Study:

• To assess the long-term efficacy and safety of aortic homograft root replacement in pediatric patients.
• To determine survival rates and the need for reintervention after aortic homograft implantation.
• To provide data on the durability of aortic homografts in children.

Main Methods:

• Retrospective review of electronic medical records for 38 children who underwent aortic homograft root replacement between 2004 and 2021.
• Analysis of survival and reintervention rates as primary endpoints.
• Kaplan-Meier survival analysis was performed.

Main Results:

• No early mortality; 5.3% late mortality with 2 deaths.
• 21% of homografts required replacement, with no deaths post-replacement.
• 74% of homografts functioned well at a median follow-up of 81 months.
• Actuarial reintervention-free survival was 50% at 224 months; estimated survival at 220 months was 90%.

Conclusions:

• Aortic homograft root replacement is a reasonable option for pediatric aortic valve disease.
• While some homografts necessitate future replacement, the procedure is safe with a low risk of reoperation.
• Long-term survival is favorable, supporting the use of aortic homografts in children.