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Eur J Cardiothorac Surg 1998;13:565-571
© 1998 Elsevier Science NL

Aortic valve replacement in children: are we on the right track?¹

Department of Cardiovascular Surgery, German Heart Center at Technical University, Munich, Germany

Received 29 September 1997; received in revised form 23 February 1998; accepted 2 March 1998.

Corresponding author. Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum an der Technischen Universität München, Lazarettstraße 36, 80636 München, Germany. Tel.: +49 89 12184117; fax: +49 089 12184113; e-mail: mazzitelli@dhm.mhn.de

Objective: The choice of the ideal prosthesis for aortic valve replacement (AVR) in children is still controversial. Early degeneration of bioprostheses and the potential risks related to anticoagulation in the child have renewed the interest of many surgeons towards the Ross operation. This study concerns our 22-year experience with AVR in children. Methods: Forty-six children, aged 4 months to 16 years (mean 11.6 years), had AVR between April 1974 and December 1996. Preoperative diagnosis revealed aortic regurgitation (AR) in 25 cases, aortic stenosis (AS) in ten, combined AS and AR in nine and LVOTO in two patients. Of the 46 patients, 26 had 37 previous procedures. Isolated AVR was performed in 19 cases, 27 children underwent 36 concomitant intracardiac procedures. Mechanical prostheses were implanted in 30 children, bioprostheses in eight, aortic homografts in three. Five patients underwent a Ross procedure. Results: There was one hospital death in the latter group (2.1%). Six of seven late deaths occurred in patients who underwent complex intracardiac procedures (15.2%). Reoperation rate was 19.5% (n=10), differentiating 16.6% for mechanical (5/30 patients) and 50% (4/8 patients) for bioprostheses. The mean follow-up period was 8.01 years, ranging from 0.45 to 21.66 years (304.04 patient-years). There was one hemorragic event (2.1%) due to anticoagulation, thrombosis of the mechanical valve occurred in two patients (4.2%). Conclusions: AVR can be performed with acceptable mortality rate and good long-term results in children. We perform the Ross operation only in selected cases. According to our experience, mechanical prostheses show excellent performances in children with a low incidence of complications related to anticoagulation.

Key Words: Valve replacement • Children • Ross operation

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