Primary Aortic Root Replacement Outcomes and Risk Factors in Pediatric Patients

• Published in: The Annals of thoracic surgery Vol. 110; no. 1; pp. 189 - 197
• Main Authors: Binsalamah, Ziyad M., Ibarra, Christopher, Spigel, Zachary, Zea-Vera, Rodrigo, Zink, Jessica, Heinle, Jeffrey S., Caldarone, Christopher A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.07.2020
• Subjects: Age Factors; Aortic Valve Insufficiency - complications; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - surgery; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Bioprosthesis; Child; Child, Preschool; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - methods; Humans; Infant; Male; Postoperative Complications - epidemiology; Retrospective Studies; Risk Factors; Survival Rate; Treatment Outcome
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2020.02.060

The study sought to identify the optimal aortic root replacement (ARR) strategy for pediatric patients, and a single-center experience was analyzed. Retrospective review of patients undergoing ARR from 1995 to 2018 was performed. Patients were stratified by surgical strategy (pulmonary autograft [Ross procedure], aortic homograft, mechanical valve conduit [Bentall procedure], or porcine xenograft [Freestyle bioprosthesis]) and aortic annulus size. ARR was performed in 206 patients with a median follow-up of 5.0 (interquartile range, 1.4-11.4) years. Root replacements included Ross procedure (n = 98), homograft (n = 83), Bentall procedure (n = 18), and Freestyle bioprosthesis (n = 7). Overall survival was 92%, and freedom from reoperation or death was 81%. Reoperation-free survival was superior in the Ross group when compared with other groups. Because surgical options differ based on the size of the aortic annulus, the analysis was arbitrarily stratified. When the aortic annulus diameter was greater than 19 mm (n = 74), procedures included Ross procedure (n = 23), homograft (n = 29), Bentall procedure (n = 17), and Freestyle bioprosthesis (n = 5). Reoperation-free survival at median follow-up (5 years) was 86%, 58%, 100%, and 100%, respectively. The Bentall procedure offered the longest freedom from reoperation. In the subset with aortic annulus diameter less than 19 mm and a pulmonary valve suitable for a Ross procedure, patients underwent the Ross procedure (n = 75) or homograft ARR (n = 36). At median follow-up (3.8 years), reoperation-free survival was longer after the Ross procedure than after homograft ARR (88% vs 46%; P < .001). In patients with a large aortic annulus, a Bentall ARR offers the longest reoperation-free survival. For patients with small aortic roots, a Ross procedure provides better a reoperation-free survival than does homograft ARR. [Display omitted]