Valve Sparing Aortic Root Surgery In Pediatric Patients: A Single Center Experience
Ismail Bouhout, David Blitzer, David Kalfa, Emile Bacha.
Columbia University, New York, NY, USA.
Objectives: Valve-sparing root replacement (VSRR) is well-established in adults with less evidence in children. Methods: A single institutional review of children<18 years old undergoing VSRR from 2006 to 2021 was performed. The primary endpoint was a composite of aortic valve (AV) re-intervention, postoperative aortic stenosis (AS) and aortic regurgitation (AR). Median follow-up was 3 (0.7-4.4) years. Results: 15 patients met inclusion criteria (male=11, 73%), with a median age of 14 years (9-17). Connective tissue disease was present in 60% (n=9) of patients (Marfan=6, 40%; Loeys-Dietz=2, 13%, Other=1, 7%), and bicuspid AV was present in 20% (n=3) of patients. Median preoperative annulus size was 22mm (18-22) with a median z-score=2 (1-3) and a median sinus of Valsalva size of 38mm (34-43)(Z-score=6; 4-8). Cardiopulmonary bypass and cross clamp times were 165(132-191) and 123(111-155) minutes, respectively. A graft sized 28m was implanted in 50% (n=7) of cases. There was no perioperative mortality. The Kaplan-Meier incidence of AV reintervention or AS/AR≥2 was 26 ±13% at 5 years. Three patients had an AV reintervention for progressive AR at a median of 3.8(1.9;6.0) years. Two patients had a prosthetic AV replacement and one had a successful repair. There was no association between an AR>mild at discharge or graft size and subsequent AV reintervention or AS/AR≥2. Conclusion: VSRR can be safely performed in pediatric patients with risk of progressive AV disease or reintervention.
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