Outcome of a Repair-Oriented Strategy for the Aortic Valve in Children

Abstract

We sought to evaluate the mid-term results of a repair-oriented strategy of the aortic valve in children. 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. 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. 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.