Aortic valve replacement in preteenage children

During the last 15 years, 26 children who ranged from 4 to 12 years old underwent subcoronary aortic valve replacement (AVR) at the Texas Heart Institute. The valve lesions resulted from congenital heart disease in 20 patients, 15 of whom had had a previous operation including 13 aortic valve procedures. Cystic medial necrosis necessitated AVR in 5 patients, all of whom had physical findings of Marfan's syndrome. One patient had rheumatic heart disease and required double-valve (aortic and mitral) replacement. Six different types of prosthesis were used: the Smeloff-Cutter, Starr-Edwards, Cooley-Cutter, Hancock porcine, Ionescu-Shiley, and Bjork-Shiley. The first patient in the series was the only early death (3.8%). Log-term follow-up data ranging from 1 month to 10 years were available on 20 patients. Three late deaths occurred (11.5%). All survivors are doing well and have good exercise tolerance. These data suggest that AVR performed in childhood is a safe, durable, and well-tolerated form of therapy. Later replacement, if necessary, can be accomplished with larger-sized prostheses. Our present choice is the Ionescu-Shiley bovine xenograft because of its superior hemodynamic characteristics and low incidence of embolic complications.