Aortic valve replacement in pediatric patients: 30 years single center experience

Abstract

Background The choice of aortic valve replacement needs to be decided in an interdisciplinary approach and together with the patients and their families regarding the need for re-operation and risks accompanying anticoagulation. We report long-term outcomes after different AVR options. Methods A chart review of patients aged < 18 years at time of surgery, who had undergone AVR from May 1985 until April 2020 was conducted. Contraindications for Ross procedure, which is performed since 1991 at the center were reviewed in the observed non-Ross AVR cohort. The study endpoints were compared between the mechanical AVR and the biological AVR cohort. Results From May 1985 to April 2020 fifty-five patients received sixty AVRs: 33 mechanical AVRs and 27 biological AVRs. In over half of the fifty-three AVRs performed after 1991 (58.5%; 31/53) a contraindication for Ross procedure was present. Early mortality was 5% (3/60). All early deaths occurred in patients aged < 1 year at time of surgery. Two late deaths occurred and survival was 94.5% ± 3.1% at 10 years and 86.4% ± 6.2% at 30 years. Freedom from aortic valve re-operation was higher (p < 0.001) in the mechanical AVR than in the biological AVR cohort with 95.2% ± 4.6% and 33.6% ± 13.4% freedom from re-operation at 10 years respectively. Conclusions Re-operation was less frequent in the mechanical AVR cohort than in the biological AVR cohort. For mechanical AVR, the risk for thromboembolic and bleeding events was considerable with a composite linearized event rate per valve-year of 3.2%.

Paediatric aortic valve replacement using decellularized allografts: a multicentre update following 143 implantations and five-year mean follow-up

“…For our analysis, we used a conservative estimation of thromboembolic complications in mechanical AVR of 1.5% per year [ 6 ]. However, in a 30-year single-centre retrospective analysis at the University of Vienna, Schlein et al found a considerably higher risk for thromboembolic and bleeding events with a composite linearized event rate per valve-year of 3.2% [ 22 ]. Had our study been based on this event rate, mechanical AVR would not have shown lower adverse events than Ross procedures.…”

Partial heart transplantation can ameliorate donor organ utilization

“…Small sizes exist for the pediatric population, and multiple methods have been described to fit larger prostheses into smaller patients via special annular enlargement techniques, such as the Nicks and Manouguian procedures 4–6 . This can be successful in older children, but the smallest commercially available valve of 16 mm is not small enough for many infants and small children despite these efforts 7 . Therefore, mechanical valves do not solve the issue of increased mortality from CHD in infants <1 year of age.…”

“…[4][5][6] This can be successful in older children, but the smallest commercially available valve of 16 mm is not small enough for many infants and small children despite these efforts. 7 Therefore, mechanical valves do not solve the issue of increased mortality from CHD in infants <1 year of age. Mechanical valves are more durable than some other replacement options such as xenografts.…”

Paediatrician’s guide to post-operative care for biventricular CHD: a review

“…Mechanical valves have the potential to last a lifetime but require chronic anticoagulation, carrying roughly a 1-3% risk of thrombosis or bleeding per valve-year. 43,44 Neither of these valves have potential to grow with the child. Paediatricians can serve as important allies in encouraging adherence to anticoagulation, oral hygiene, and endocarditis prophylaxis recommendations, as non-adherence can rapidly lead to complications including aortic stenosis, aortic insufficiency, and endocarditis.…”