Mechanical Aortic Valve Replacement in Children and Adolescents After Previous Repair of Congenital Heart Disease

Abstract

Due to improved outcome after surgery for congenital heart defects, children, adolescents, and grown-ups with congenital heart defects become an increasing population. In order to evaluate operative risk and early outcome after mechanical aortic valve replacement (AVR) in this population, we reviewed patients who underwent previous repair of congenital heart defects. Between July 2002 and November 2008, 15 (10 male and 5 female) consecutive patients (mean age 14.5 +/- 10.5 years) underwent mechanical AVR. Hemodynamic indications for AVR were aortic stenosis in four (27%), aortic insufficiency in eight (53%), and mixed disease in three (20%) after previous repair of congenital heart defects. All patients had undergone one or more previous cardiovascular operations due to any congenital heart disease. Concomitant cardiac procedures were performed in all of them. In addition to AVR, in two patients, a mitral valve exchange was performed. One patient received a right ventricle-pulmonary artery conduit replacement as concomitant procedure. The mean size of implanted valves was 23 mm (range 17-29 mm). There were neither early deaths nor late mortality until December 2008. Reoperations were necessary in five (33%) and included implantation of a permanent pacemaker due to complete atrioventricular block in two (15%), mitral valve replacement with a mechanical prosthesis due to moderate to severe mitral regurgitation in one (7%), aortocoronary bypass grafting due to stenosis of a coronary artery in one (7%), and in one (7%), a redo subaortic stenosis resection was performed because of a secondary subaortic stenosis. At the latest clinical evaluation, all patients were in good clinical condition without a pathological increased gradient across the aortic valve prosthesis or paravalvular leakage in echocardiography. Mechanical AVR has excellent results in patients after previous repair of congenital heart defects in childhood, even in combination with complex concomitant procedures. Previous operations do not significantly affect postoperative outcome.

Contemporary experience with surgical treatment of aortic valve disease in children

“…Both factors appear to have no impact on outcomes as described by others. 22,23 Our results with the use of mechanical valves confirm that this valve can be reliably used in the pediatric population if anticoagulation can be appropriately managed. In our cohort, 9% of patients who were on anticoagulation had a complication at long-term follow-up.…”

Predictors of Left Ventricular Remodeling after Aortic Valve Replacement in Pediatric Patients with Isolated Aortic Regurgitation

“…The outcomes still have been favorable with no surgical mortality as shown in previous studies where mechanical AVR had excellent results in patients after previous repair of congenital heart defects in childhood, even in combination with complex concomitant procedures. 2 It was shown in previous studies that other echo parameters can predict severity of AR. 20 In our study, however, echo parameters including the width and length of the AR jet, severity of diastolic flow reversal in the descending aorta, and left ventricular end-diastolic volume did not predict outcomes.…”

“…1 Aortic valve replacement has been shown to improve hemodynamics in children with moderate to severe AR. 2,3 The American Heart Association has published guidelines for the management of children with isolated AR. The indication for surgery is similar to that for adults, that is, New York Heart Association (NYHA) functional class III/IV symptoms, LV dysfunction (LV ejection fraction <50%), or progressive LV enlargement (end-diastolic dimension >4 standard deviation (SD) above normal for body surface area and weight).…”

Artificial Organs 2009: A Year in Review

“…Aron‐Frederik Popov et al. (138) of the University of Göttingen, Göttingen, Germany evaluated operative risk and early outcome after mechanical aortic valve replacement (AVR) in children and adolescent populations. Fifteen (10 male and 5 female) consecutive patients (mean age 14.5 years) underwent mechanical AVR.…”