TY - JOUR
T1 - Surgery for aortic root aneurysm in children
T2 - A 21-Year experience in 50 patients
AU - Cattaneo, Stephen M.
AU - Bethea, Brian T.
AU - Alejo, Diane E.
AU - Spevak, Philip J.
AU - Clauss, Sarah B.
AU - Dietz, Harry C.
AU - Gott, Vincent L.
AU - Cameron, Duke Edward
N1 - Funding Information:
This study was supported in part by the Dana and Albert “Cubby” Broccoli Center for Aortic Diseases at the Johns Hopkins Medical Institutions, by the Mildred and Carmont Blitz Cardiac Research Fund, National Institutes of Health Grant R01-AR41135, the Howard Hughes Medical Institute, and the Smilow Family Foundation. Doctor Cattaneo is an Irene Piccinini Investigator, and Dr Bethea is a Hugh R. Sharp, Jr Research Fellow. We thank Drs J. Mark Redmond and Bruce A. Reitz for allowing us to include their patients in this report. We also wish to thank Eileen Wright and Barbara Dobbs for their assistance in preparing our manuscript.
PY - 2004/1
Y1 - 2004/1
N2 - Background. Ascending aortic aneurysms are unusual in children and have received little attention to develop guidelines for management. This study reviewed our experience with 50 children who have undergone aortic root replacement for ascending aortic aneurysm. Methods. A retrospective clinical review was conducted using hospital charts and office records. Patients or their physicians were contacted for follow-up and recent echocardiograms were obtained and reviewed. Results. There was no operative or hospital mortality. Twenty-six children had aortic root replacement with a composite graft, 10 patients had replacement with a homograft aortic root, and 14 patients had a David II valve-sparing procedure. Factors related to late morbidity and mortality were analyzed. Long-term results were excellent in the 26 children receiving a composite graft. Twenty-three of these children were New York Heart Association class I (19) or II (4) at study closure. There were 3 late deaths (11, 16, and 17 years postoperative). Seven of 10 children receiving a homograft aortic root are long-term survivors and all 14 children having a valve-sparing procedure are alive. Generally, late results with the David II remodeling procedure have been good although 3 patients developed late aortic insufficiency and two required valve replacement. Conclusions. Aortic root replacement in children with aneurysms has low operative risk and good long-term results. Composite grafts in particular carry a low risk of endocarditis, thromboembolism, and hemorrhagic events. Homografts are suitable for small patients but lack durability. Late results with the David II remodeling valve-sparing procedure in children have been compromised by late root dilatation.
AB - Background. Ascending aortic aneurysms are unusual in children and have received little attention to develop guidelines for management. This study reviewed our experience with 50 children who have undergone aortic root replacement for ascending aortic aneurysm. Methods. A retrospective clinical review was conducted using hospital charts and office records. Patients or their physicians were contacted for follow-up and recent echocardiograms were obtained and reviewed. Results. There was no operative or hospital mortality. Twenty-six children had aortic root replacement with a composite graft, 10 patients had replacement with a homograft aortic root, and 14 patients had a David II valve-sparing procedure. Factors related to late morbidity and mortality were analyzed. Long-term results were excellent in the 26 children receiving a composite graft. Twenty-three of these children were New York Heart Association class I (19) or II (4) at study closure. There were 3 late deaths (11, 16, and 17 years postoperative). Seven of 10 children receiving a homograft aortic root are long-term survivors and all 14 children having a valve-sparing procedure are alive. Generally, late results with the David II remodeling procedure have been good although 3 patients developed late aortic insufficiency and two required valve replacement. Conclusions. Aortic root replacement in children with aneurysms has low operative risk and good long-term results. Composite grafts in particular carry a low risk of endocarditis, thromboembolism, and hemorrhagic events. Homografts are suitable for small patients but lack durability. Late results with the David II remodeling valve-sparing procedure in children have been compromised by late root dilatation.
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U2 - 10.1016/S0003-4975(03)01332-8
DO - 10.1016/S0003-4975(03)01332-8
M3 - Article
C2 - 14726057
AN - SCOPUS:1642564222
VL - 77
SP - 168
EP - 176
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 1
ER -