Outcome of a repair-oriented strategy for the aortic valve in children.

BACKGROUND: We sought to evaluate the mid-term results of a repair-oriented strategy of the aortic valve in children. METHODS: Between February 2007 and November 2011, we performed 39 aortic valve repairs in children. Median age and weight at surgery were 5.5 years (3 days-18 years) and 16.7 kg (2.7-83.5), respectively. A total of 11 (28%) patients had one or more prior surgical or interventional cardiologic procedures. Median intensive care unit and hospital stay were two (1-96) and five (3-96) days, respectively. Median and cumulative follow-up were 12.7 months (15 days-64 months) and 48.9 patient-years, respectively. RESULTS: There were 3 (7.7%) early deaths all in patients undergoing additional complex cardiac procedures. Two (5.1%) patients required early surgical revision. Twenty-six (66%) patients had isolated or mixed aortic stenosis. The median gradient reduced from 62.4 (range 16-144) to 17.6 mm Hg (range 0-51.8), postoperatively (P = .02). At last follow-up, the median gradient remained largely unchanged at 21.1 mm Hg (0-49; P = .02). Twenty-six (66%) patients had isolated or mixed aortic valve regurgitation (mild in 8 [20%], moderate in 15 [38%], and severe in 6 ([15%] patients). The degree of aortic regurgitation improved in all patients with moderate or severe aortic regurgitation (P = .04). At last follow-up, two patients had moderate aortic regurgitation. Kaplan Meier freedom from reintervention in the survivors was 95% at three years. CONCLUSIONS: A repair-oriented strategy for the aortic valve in children has satisfactory early and mid-term results and remains a promising management option in children with aortic valve disease.

Bovine jugular vein valved conduit: up to 10 years follow-up.

OBJECTIVE: The present study evaluated the mortality and conduit failure in bovine jugular vein (BJV) conduits. METHODS: Between October 1999 and February 2009, 193 patients (mean age, 6.7 ± 5.8 years; range, 5 days to 18 years; mean weight, 23.9 ± 21.0 kg; range, 2.4-105.4 kg) had been discharged after BJV implantation. The reason for BJV implantation was right ventricular outflow tract reconstruction in 117 conduit replacement in 44, and the Ross procedure in 32. The diameter of the BJV was 12 mm in 18 patients (9.3%), 14 mm in 16 (8.3%), 16 mm in 42 (21.7%), 18 mm in 37 (19.2%), 20 mm in 15 (7.8%), and 22 mm in 65 (33.7%). RESULTS: At a mean ± SD follow-up of 4.6 ± 2.3 y/patient (range, 8 months to 10 years), 5 late deaths (2.6%) had occurred, all unrelated to conduit failure. Conduit-related problems required an interventional procedure as the first treatment in 10 patients (5.2%) within a mean interval of 2.5 ± 1.4 years (range, 8 months to 5.3 years) or surgical revision in 5 patients (2.6%) after 2.1 ± 1.9 years (range, 19 days to 4.1 years). Late deaths occurred in 5.9% (2/34) of patients with a BJV size of 12 to 14 mm versus 1.9% (3/159) in patients with a size of 16 to 22 mm (P = NS). An interventional procedure or surgical revision was required in 29.4% (10/34) of patients with a BJV size of 12 to 14 mm versus 3.1% (5/159) in patients with a size of 16 to 22 mm (P < .0005). CONCLUSIONS: After 10 years of experience with the BJV, this conduit has remained a reliable alternative to pulmonary homografts with respect to survival and freedom from conduit failure. However, the incidence was greater and the presentation of conduit failure was earlier in patients with a smaller size BJV conduit (12-14 mm).