Valve-sparing aortic root replacement in children: Outcomes from 100 consecutive cases

Charles D. Fraser, Rui Han Liu, Xun Zhou, Nishant Patel, Cecillia Lui, Alejandro Suarez Pierre, Marshall L. Jacobs, Harry C. Dietz, Jennifer Habashi, Narutoshi Hibino, Duke Edward Cameron, Luca A. Vricella

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Objective: Valve-sparing root replacement is an attractive alternative to composite mechanical or biologic prostheses for aortic root aneurysms in children. Data on outcomes in pediatric patients are limited. We present our institutional experience with 100 consecutive pediatric valve-sparing aortic root procedures. Methods: All children who underwent valve-sparing root replacement at our institution from May 1997 to August 2017 were identified, and echocardiographic and clinical data were reviewed. The primary end point was mortality, and secondary end points included complications, further interventions, and subsequent valvular dysfunction. Results: Median age at operation was 13.6 years (interquartile range, 9.42-15.9); 51 patients (51%) had Marfan syndrome, and 39 patients (39%) had Loeys–Dietz syndrome. Mean preoperative maximum sinus diameter was 4.4 ± 0.71 cm (z score 7.3 [5.7-9.3]). Most patients (n = 80, 80%) underwent reimplantation procedures with a Valsalva graft. Four patients (4%) underwent David I reimplantation with a straight-tube graft, 13 patients (13%) underwent a Yacoub remodeling procedure, and 3 patients (3%) underwent a Florida sleeve procedure. Perioperative valve-sparing root replacement mortality was 2% (n = 2). Six patients required late reintervention for development of pseudoaneurysms. Eight patients underwent additional aortic surgery. Average time to reoperation was 7.23 ± 4.56 years. Of the 84 patients undergoing a reimplantation procedure, 5 (5.9%) underwent late valve replacement versus 5 (33.3%) of the 15 patients who received a remodeling procedure (P =.001). Conclusions: Valve-sparing root replacement is a safe and effective option for children with aortic root aneurysms in children. The reimplantation procedure is preferred. Late aortic insufficiency and pseudoaneurysm formation remain late concerns.

Original languageEnglish (US)
Pages (from-to)1100-1109
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume157
Issue number3
DOIs
StatePublished - Mar 2019

Keywords

  • Loeys–Dietz syndrome
  • Marfan syndrome
  • pediatrics
  • valve-sparing aortic root replacement

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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