Valve-sparing aortic root replacement in children: Intermediate-term results

Nishant D. Patel, George J. Arnaoutakis, Timothy J. George, Jeremiah G. Allen, Diane E. Alejo, Harry C Dietz, Duke E. Cameron, Luca Vricella

Research output: Contribution to journalArticle

Abstract

Valve-sparing root replacement (VSRR) is an attractive option for aortic aneurysm in children with low-operative risk, but mid- and late-term results are not yet known. Between 1997 and 2009, 56 children (mean age 11.5 years) underwent VSRR at our institution. Twenty-six (46.4%) had Marfan syndrome and 24 (42.8%) had Loeys-Dietz syndrome. Mean preoperative max sinus diameter was 4.2 ± 0.8 cm (Z-score 7.7 ± 2.9). Five (8.9%) had >2± aortic insufficiency (AI). Two (3.6%) underwent David I reimplantation with a straight-tube, 12 (21.4%) had a Yacoub remodeling procedure, and 42 (75.0%) had reimplantation using a Valsalva-graft. There were one (1.8%) operative and three (5.4%) late deaths. One patient required reoperation for bleeding and one required late repair of a distal pseudoaneurysm. Mean follow-up was 5.2 years (range 0-12 years). No patients suffered thromboembolic events or had endocarditis. Of the 12 remodeling patients, four (33.3%) developed >2± AI and required aortic valve repair or replacement. No patient developed >2± AI after reimplantation. VSRR in children is a safe alternative to aortic root replacement with mechanical or biological prostheses. In this particular group of patients with connective tissue disorders and proclivity toward annular dilation and late AI, reimplantation is superior to remodeling.

Original languageEnglish (US)
Pages (from-to)415-419
Number of pages5
JournalInteractive Cardiovascular and Thoracic Surgery
Volume12
Issue number3
DOIs
StatePublished - Mar 2011

Fingerprint

Aortic Valve
Replantation
Loeys-Dietz Syndrome
Marfan Syndrome
Aortic Valve Insufficiency
Aortic Aneurysm
False Aneurysm
Endocarditis
Reoperation
Connective Tissue
Prostheses and Implants
Dilatation
Hemorrhage
Transplants

Keywords

  • Aortic aneurysm
  • Aortic root replacement
  • Pediatric

ASJC Scopus subject areas

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

Cite this

Valve-sparing aortic root replacement in children : Intermediate-term results. / Patel, Nishant D.; Arnaoutakis, George J.; George, Timothy J.; Allen, Jeremiah G.; Alejo, Diane E.; Dietz, Harry C; Cameron, Duke E.; Vricella, Luca.

In: Interactive Cardiovascular and Thoracic Surgery, Vol. 12, No. 3, 03.2011, p. 415-419.

Research output: Contribution to journalArticle

Patel, Nishant D. ; Arnaoutakis, George J. ; George, Timothy J. ; Allen, Jeremiah G. ; Alejo, Diane E. ; Dietz, Harry C ; Cameron, Duke E. ; Vricella, Luca. / Valve-sparing aortic root replacement in children : Intermediate-term results. In: Interactive Cardiovascular and Thoracic Surgery. 2011 ; Vol. 12, No. 3. pp. 415-419.
@article{91a28891e9644f77a9c639e1817df88e,
title = "Valve-sparing aortic root replacement in children: Intermediate-term results",
abstract = "Valve-sparing root replacement (VSRR) is an attractive option for aortic aneurysm in children with low-operative risk, but mid- and late-term results are not yet known. Between 1997 and 2009, 56 children (mean age 11.5 years) underwent VSRR at our institution. Twenty-six (46.4{\%}) had Marfan syndrome and 24 (42.8{\%}) had Loeys-Dietz syndrome. Mean preoperative max sinus diameter was 4.2 ± 0.8 cm (Z-score 7.7 ± 2.9). Five (8.9{\%}) had >2± aortic insufficiency (AI). Two (3.6{\%}) underwent David I reimplantation with a straight-tube, 12 (21.4{\%}) had a Yacoub remodeling procedure, and 42 (75.0{\%}) had reimplantation using a Valsalva-graft. There were one (1.8{\%}) operative and three (5.4{\%}) late deaths. One patient required reoperation for bleeding and one required late repair of a distal pseudoaneurysm. Mean follow-up was 5.2 years (range 0-12 years). No patients suffered thromboembolic events or had endocarditis. Of the 12 remodeling patients, four (33.3{\%}) developed >2± AI and required aortic valve repair or replacement. No patient developed >2± AI after reimplantation. VSRR in children is a safe alternative to aortic root replacement with mechanical or biological prostheses. In this particular group of patients with connective tissue disorders and proclivity toward annular dilation and late AI, reimplantation is superior to remodeling.",
keywords = "Aortic aneurysm, Aortic root replacement, Pediatric",
author = "Patel, {Nishant D.} and Arnaoutakis, {George J.} and George, {Timothy J.} and Allen, {Jeremiah G.} and Alejo, {Diane E.} and Dietz, {Harry C} and Cameron, {Duke E.} and Luca Vricella",
year = "2011",
month = "3",
doi = "10.1510/icvts.2010.255596",
language = "English (US)",
volume = "12",
pages = "415--419",
journal = "Interactive Cardiovascular and Thoracic Surgery",
issn = "1569-9293",
publisher = "European Association for Cardio-Thoracic Surgery",
number = "3",

}

TY - JOUR

T1 - Valve-sparing aortic root replacement in children

T2 - Intermediate-term results

AU - Patel, Nishant D.

AU - Arnaoutakis, George J.

AU - George, Timothy J.

AU - Allen, Jeremiah G.

AU - Alejo, Diane E.

AU - Dietz, Harry C

AU - Cameron, Duke E.

AU - Vricella, Luca

PY - 2011/3

Y1 - 2011/3

N2 - Valve-sparing root replacement (VSRR) is an attractive option for aortic aneurysm in children with low-operative risk, but mid- and late-term results are not yet known. Between 1997 and 2009, 56 children (mean age 11.5 years) underwent VSRR at our institution. Twenty-six (46.4%) had Marfan syndrome and 24 (42.8%) had Loeys-Dietz syndrome. Mean preoperative max sinus diameter was 4.2 ± 0.8 cm (Z-score 7.7 ± 2.9). Five (8.9%) had >2± aortic insufficiency (AI). Two (3.6%) underwent David I reimplantation with a straight-tube, 12 (21.4%) had a Yacoub remodeling procedure, and 42 (75.0%) had reimplantation using a Valsalva-graft. There were one (1.8%) operative and three (5.4%) late deaths. One patient required reoperation for bleeding and one required late repair of a distal pseudoaneurysm. Mean follow-up was 5.2 years (range 0-12 years). No patients suffered thromboembolic events or had endocarditis. Of the 12 remodeling patients, four (33.3%) developed >2± AI and required aortic valve repair or replacement. No patient developed >2± AI after reimplantation. VSRR in children is a safe alternative to aortic root replacement with mechanical or biological prostheses. In this particular group of patients with connective tissue disorders and proclivity toward annular dilation and late AI, reimplantation is superior to remodeling.

AB - Valve-sparing root replacement (VSRR) is an attractive option for aortic aneurysm in children with low-operative risk, but mid- and late-term results are not yet known. Between 1997 and 2009, 56 children (mean age 11.5 years) underwent VSRR at our institution. Twenty-six (46.4%) had Marfan syndrome and 24 (42.8%) had Loeys-Dietz syndrome. Mean preoperative max sinus diameter was 4.2 ± 0.8 cm (Z-score 7.7 ± 2.9). Five (8.9%) had >2± aortic insufficiency (AI). Two (3.6%) underwent David I reimplantation with a straight-tube, 12 (21.4%) had a Yacoub remodeling procedure, and 42 (75.0%) had reimplantation using a Valsalva-graft. There were one (1.8%) operative and three (5.4%) late deaths. One patient required reoperation for bleeding and one required late repair of a distal pseudoaneurysm. Mean follow-up was 5.2 years (range 0-12 years). No patients suffered thromboembolic events or had endocarditis. Of the 12 remodeling patients, four (33.3%) developed >2± AI and required aortic valve repair or replacement. No patient developed >2± AI after reimplantation. VSRR in children is a safe alternative to aortic root replacement with mechanical or biological prostheses. In this particular group of patients with connective tissue disorders and proclivity toward annular dilation and late AI, reimplantation is superior to remodeling.

KW - Aortic aneurysm

KW - Aortic root replacement

KW - Pediatric

UR - http://www.scopus.com/inward/record.url?scp=79952336923&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952336923&partnerID=8YFLogxK

U2 - 10.1510/icvts.2010.255596

DO - 10.1510/icvts.2010.255596

M3 - Article

C2 - 21118834

AN - SCOPUS:79952336923

VL - 12

SP - 415

EP - 419

JO - Interactive Cardiovascular and Thoracic Surgery

JF - Interactive Cardiovascular and Thoracic Surgery

SN - 1569-9293

IS - 3

ER -