Early experience with valve-sparing aortic root replacement in children

Luca A. Vricella, Jason A. Williams, William J. Ravekes, Kathryn Holmes, Harry C. Dietz, Vincent L. Gott, Duke E. Cameron

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background. Aortic valve-sparing root replacement has become an established treatment for adults with aneurysms of the ascending aorta, but there is limited experience in children, for whom the advantages of avoiding valve prostheses are particularly attractive. Methods. A retrospective clinical study was undertaken to examine results of aortic valve-sparing operations in pediatric patients at a single institution. Clinical and echocardiographic data were obtained from chart review and outpatient follow-up examination. Results. Between 1997 and 2004, 19 children underwent aortic valve-sparing root replacement. Mean age was 12.2 ± 4.4 years, and mean weight was 51.5 ± 22.9 kg. Median length of clinical follow-up was 58 months (range, 5 to 91). Fifteen of 19 patients (78.9%) had Marfan syndrome and 1 had aortic root dilation late after the arterial switch operation. Mean preoperative root diameter was 4.7 ± 0.6 cm, with an average Z score of 7.7 ± 1.9. Fourteen patients (73.7%) underwent root remodeling, whereas 5 (26.3%) had a reimplantation procedure. One patient required concomitant mitral valve repair. There was no operative mortality and only 1 reoperation for bleeding (5.3%). Median length of hospital stay was 5 days (range, 3 to 12). At latest follow-up, 3 of 19 patients (15.8%) have required late aortic valve replacement. Fifteen patients have no or mild aortic valve insufficiency, and 1 has moderate but stable valve regurgitation. No patient with a reimplantation procedure has had a reoperation or more than mild insufficiency, and no patient has suffered endocarditis or thromboembolism. Conclusions. Valve-sparing aortic root replacement is a viable alternative to root replacement with mechanical or biological prostheses in children, and can be accomplished with minimal morbidity and mortality. Reimplantation procedures appear to have more durable results than root remodeling techniques, and should be strongly considered for pediatric patients with aortic root enlargement secondary to connective tissue disorders and other forms of congenital heart disease.

Original languageEnglish (US)
Pages (from-to)1622-1627
Number of pages6
JournalAnnals of Thoracic Surgery
Volume80
Issue number5
DOIs
StatePublished - Nov 2005
Externally publishedYes

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Aortic Valve
Replantation
Reoperation
Prostheses and Implants
Length of Stay
Pediatrics
Aortic Valve Insufficiency
Mortality
Thromboembolism
Endocarditis
Mitral Valve
Connective Tissue
Aneurysm
Aorta
Dilatation
Heart Diseases
Outpatients
Retrospective Studies
Hemorrhage
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Vricella, L. A., Williams, J. A., Ravekes, W. J., Holmes, K., Dietz, H. C., Gott, V. L., & Cameron, D. E. (2005). Early experience with valve-sparing aortic root replacement in children. Annals of Thoracic Surgery, 80(5), 1622-1627. https://doi.org/10.1016/j.athoracsur.2005.04.062

Early experience with valve-sparing aortic root replacement in children. / Vricella, Luca A.; Williams, Jason A.; Ravekes, William J.; Holmes, Kathryn; Dietz, Harry C.; Gott, Vincent L.; Cameron, Duke E.

In: Annals of Thoracic Surgery, Vol. 80, No. 5, 11.2005, p. 1622-1627.

Research output: Contribution to journalArticle

Vricella, LA, Williams, JA, Ravekes, WJ, Holmes, K, Dietz, HC, Gott, VL & Cameron, DE 2005, 'Early experience with valve-sparing aortic root replacement in children', Annals of Thoracic Surgery, vol. 80, no. 5, pp. 1622-1627. https://doi.org/10.1016/j.athoracsur.2005.04.062
Vricella, Luca A. ; Williams, Jason A. ; Ravekes, William J. ; Holmes, Kathryn ; Dietz, Harry C. ; Gott, Vincent L. ; Cameron, Duke E. / Early experience with valve-sparing aortic root replacement in children. In: Annals of Thoracic Surgery. 2005 ; Vol. 80, No. 5. pp. 1622-1627.
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abstract = "Background. Aortic valve-sparing root replacement has become an established treatment for adults with aneurysms of the ascending aorta, but there is limited experience in children, for whom the advantages of avoiding valve prostheses are particularly attractive. Methods. A retrospective clinical study was undertaken to examine results of aortic valve-sparing operations in pediatric patients at a single institution. Clinical and echocardiographic data were obtained from chart review and outpatient follow-up examination. Results. Between 1997 and 2004, 19 children underwent aortic valve-sparing root replacement. Mean age was 12.2 ± 4.4 years, and mean weight was 51.5 ± 22.9 kg. Median length of clinical follow-up was 58 months (range, 5 to 91). Fifteen of 19 patients (78.9{\%}) had Marfan syndrome and 1 had aortic root dilation late after the arterial switch operation. Mean preoperative root diameter was 4.7 ± 0.6 cm, with an average Z score of 7.7 ± 1.9. Fourteen patients (73.7{\%}) underwent root remodeling, whereas 5 (26.3{\%}) had a reimplantation procedure. One patient required concomitant mitral valve repair. There was no operative mortality and only 1 reoperation for bleeding (5.3{\%}). Median length of hospital stay was 5 days (range, 3 to 12). At latest follow-up, 3 of 19 patients (15.8{\%}) have required late aortic valve replacement. Fifteen patients have no or mild aortic valve insufficiency, and 1 has moderate but stable valve regurgitation. No patient with a reimplantation procedure has had a reoperation or more than mild insufficiency, and no patient has suffered endocarditis or thromboembolism. Conclusions. Valve-sparing aortic root replacement is a viable alternative to root replacement with mechanical or biological prostheses in children, and can be accomplished with minimal morbidity and mortality. Reimplantation procedures appear to have more durable results than root remodeling techniques, and should be strongly considered for pediatric patients with aortic root enlargement secondary to connective tissue disorders and other forms of congenital heart disease.",
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AU - Vricella, Luca A.

AU - Williams, Jason A.

AU - Ravekes, William J.

AU - Holmes, Kathryn

AU - Dietz, Harry C.

AU - Gott, Vincent L.

AU - Cameron, Duke E.

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N2 - Background. Aortic valve-sparing root replacement has become an established treatment for adults with aneurysms of the ascending aorta, but there is limited experience in children, for whom the advantages of avoiding valve prostheses are particularly attractive. Methods. A retrospective clinical study was undertaken to examine results of aortic valve-sparing operations in pediatric patients at a single institution. Clinical and echocardiographic data were obtained from chart review and outpatient follow-up examination. Results. Between 1997 and 2004, 19 children underwent aortic valve-sparing root replacement. Mean age was 12.2 ± 4.4 years, and mean weight was 51.5 ± 22.9 kg. Median length of clinical follow-up was 58 months (range, 5 to 91). Fifteen of 19 patients (78.9%) had Marfan syndrome and 1 had aortic root dilation late after the arterial switch operation. Mean preoperative root diameter was 4.7 ± 0.6 cm, with an average Z score of 7.7 ± 1.9. Fourteen patients (73.7%) underwent root remodeling, whereas 5 (26.3%) had a reimplantation procedure. One patient required concomitant mitral valve repair. There was no operative mortality and only 1 reoperation for bleeding (5.3%). Median length of hospital stay was 5 days (range, 3 to 12). At latest follow-up, 3 of 19 patients (15.8%) have required late aortic valve replacement. Fifteen patients have no or mild aortic valve insufficiency, and 1 has moderate but stable valve regurgitation. No patient with a reimplantation procedure has had a reoperation or more than mild insufficiency, and no patient has suffered endocarditis or thromboembolism. Conclusions. Valve-sparing aortic root replacement is a viable alternative to root replacement with mechanical or biological prostheses in children, and can be accomplished with minimal morbidity and mortality. Reimplantation procedures appear to have more durable results than root remodeling techniques, and should be strongly considered for pediatric patients with aortic root enlargement secondary to connective tissue disorders and other forms of congenital heart disease.

AB - Background. Aortic valve-sparing root replacement has become an established treatment for adults with aneurysms of the ascending aorta, but there is limited experience in children, for whom the advantages of avoiding valve prostheses are particularly attractive. Methods. A retrospective clinical study was undertaken to examine results of aortic valve-sparing operations in pediatric patients at a single institution. Clinical and echocardiographic data were obtained from chart review and outpatient follow-up examination. Results. Between 1997 and 2004, 19 children underwent aortic valve-sparing root replacement. Mean age was 12.2 ± 4.4 years, and mean weight was 51.5 ± 22.9 kg. Median length of clinical follow-up was 58 months (range, 5 to 91). Fifteen of 19 patients (78.9%) had Marfan syndrome and 1 had aortic root dilation late after the arterial switch operation. Mean preoperative root diameter was 4.7 ± 0.6 cm, with an average Z score of 7.7 ± 1.9. Fourteen patients (73.7%) underwent root remodeling, whereas 5 (26.3%) had a reimplantation procedure. One patient required concomitant mitral valve repair. There was no operative mortality and only 1 reoperation for bleeding (5.3%). Median length of hospital stay was 5 days (range, 3 to 12). At latest follow-up, 3 of 19 patients (15.8%) have required late aortic valve replacement. Fifteen patients have no or mild aortic valve insufficiency, and 1 has moderate but stable valve regurgitation. No patient with a reimplantation procedure has had a reoperation or more than mild insufficiency, and no patient has suffered endocarditis or thromboembolism. Conclusions. Valve-sparing aortic root replacement is a viable alternative to root replacement with mechanical or biological prostheses in children, and can be accomplished with minimal morbidity and mortality. Reimplantation procedures appear to have more durable results than root remodeling techniques, and should be strongly considered for pediatric patients with aortic root enlargement secondary to connective tissue disorders and other forms of congenital heart disease.

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