Aortic root replacement in children: a word of caution about valve-sparing procedures

Roubertie, François; Ali, Walid Ben; Raisky, Olivier; Tamisier, Daniel; Sidi, Daniel; Vouhé, Pascal

doi:10.1016/j.ejcts.2008.09.043

Cited by 30 publications

(24 citation statements)

References 20 publications

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“…Likewise, Roubertie and colleagues 2 reported 14 valve-sparing root replacements in children and concluded that remodeling yielded disappointing results and should be abandoned in the pediatric population. We support this notion that reimplantation technique is superior [1][2][3] because our only patient who had remodeling required the Bentall procedure 4 years later as the result of progressive annular dilatation.…”

Section: Discussionsupporting

confidence: 67%

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Valve-sparing aortic root replacement in children

Rakhra

d’Udekem

Konstantinov

2012

The Journal of Thoracic and Cardiovascular Surgery

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Aortic root dilatation is uncommon in children, with most cases related to congenital heart disease and its repair or to connective tissue disorders. 1-3 It rarely causes severe aortic insufficiency or dissection. 4 There are no clear indications for aortic root replacement in asymptomatic children. However, many clinicians would suggest replacing a significantly dilated root when an adult size graft can be implanted. The valve-sparing aortic root replacement has obvious advantages over composite graft and homograft root replacement and is progressively being introduced for pediatric root replacement. The long-term durability of this technique in children has not been defined, and the current literature has suggested that the valve-sparing procedures, especially root remodeling, may have a high failure rate. 1-3

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Section: Discussionsupporting

confidence: 67%

“…At the present time, valve-sparing aortic root replacement with reimplantation of the native valve into a graft with sinuses seems superior to aortic root replacement with a homograft or a composite graft in children. [1][2][3] Further long-term studies will be required to confirm or refute this notion.…”

Section: Discussionmentioning

confidence: 99%

Valve-sparing aortic root replacement in children

Rakhra

d’Udekem

Konstantinov

2012

The Journal of Thoracic and Cardiovascular Surgery

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“…One hypothesis is that these aortic valves have already undergone important adverse structural changes due to the aggressive nature of the disease, leading to significant cusp elongation, increase in the length of the cusp free margins and decreased effective height of coaptation. Concerning the poor mid-term results in this specific young population of patients with IMS [26,27], one might propose adopting a more aggressive approach towards the valve itself at the time of repair by systematically performing extensive resuspension of the cusps (through symmetrical plication in their mid-portions) to achieve a greater effective height of coaptation. This is similar to the parallel situation in adults, where it is mandatory to control the height of coaptation after repair.…”

Section: Connective Tissue Disordersmentioning

confidence: 99%

Ascending aorta and aortic root replacement (with or without valve sparing) in early childhood: surgical strategies and long-term outcomes

Bellaing

Pontailler

Bajolle

et al. 2019

European Journal of Cardio-Thoracic Surgery

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OBJECTIVESAortic root and ascending aorta replacements (AARs) are rarely required in the paediatric population. We report here a series of AAR performed in young children using different surgical techniques.METHODSBetween 1995 and 2017, 32 children under the age of 10 years (median age 5.4 years) underwent AAR procedures at our institution. Twenty-two (69%) had a connective tissue disease (infantile Marfan syndrome or Loeys–Dietz syndrome). We performed 11 AAR using a composite graft with a mechanical prosthesis and 21 valve-sparing procedures (10 Yacoub operations and 11 David operations). Median follow-up for operative survivors was 7.7 years (interquartile range 4.2–12.8 years).RESULTSThe cardiac-related early mortality rate was 6%. Patient survival was 91% at both 1 and 10 years. Eleven survivors (38%), all with a status of post-valve-sparing procedure, required an aortic root reintervention with an aortic valve replacement after a median interval of 4.2 years. Interestingly, only patients with infantile Marfan syndrome tended to be associated with risk of reoperation.CONCLUSIONSAortic root and AARs are safe in young children whatever the surgical procedure. Aortic valve-sparing procedures show good long-term results except in children with infantile Marfan syndrome whose ineluctable aortic annulus dilatation or aortic valve regurgitation requires reintervention after a short period.

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“…Although most patients with Marfan syndrome do not require cardiac surgery until adulthood, 235 excellent operative survival has been demonstrated in children undergoing aortic root replacement. [236][237][238] Peri-operative providers should recognise risk for pneumothorax and other pulmonary co-morbidities including pulmonary emphysema. 239 Pectus deformity or severe scoliosis may also impact surgical approach and recovery.…”

Section: Marfan Syndrome and Related Disordersmentioning

confidence: 99%

CHD associated with syndromic diagnoses: peri-operative risk factors and early outcomes

2015

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CHD is frequently associated with a genetic syndrome. These syndromes often present specific cardiovascular and non-cardiovascular co-morbidities that confer significant peri-operative risks affecting multiple organ systems. Although surgical outcomes have improved over time, these co-morbidities continue to contribute substantially to poor peri-operative mortality and morbidity outcomes. Peri-operative morbidity may have long-standing ramifications on neurodevelopment and overall health. Recognising the cardiovascular and non-cardiovascular risks associated with specific syndromic diagnoses will facilitate expectant management, early detection of clinical problems, and improved outcomes – for example, the development of syndrome-based protocols for peri-operative evaluation and prophylactic actions may improve outcomes for the more frequently encountered syndromes such as 22q11 deletion syndrome.

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Aortic root replacement in children: a word of caution about valve-sparing procedures

Cited by 30 publications

References 20 publications

Valve-sparing aortic root replacement in children

Valve-sparing aortic root replacement in children

Ascending aorta and aortic root replacement (with or without valve sparing) in early childhood: surgical strategies and long-term outcomes

CHD associated with syndromic diagnoses: peri-operative risk factors and early outcomes

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