Aortic valve replacement in neonates and infants: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 144; no. 5; pp. 1084 - 1090
• Main Authors: Woods, Ronald K., MD, PhD, Pasquali, Sara K., MD, Jacobs, Marshall L., MD, Austin, Erle H., MD, Jacobs, Jeffrey P., MD, Krolikowski, Mary, MSN, RN, Mitchell, Michael E., MD, Pizarro, Christian, MD, Tweddell, James S., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.2012; Elsevier
• Subjects: Age Factors; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aorta, Thoracic - surgery; Aortic Valve - surgery; Assisted Circulation - adverse effects; Assisted Circulation - mortality; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Chi-Square Distribution; Female; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - mortality; Hospital Mortality; Humans; Infant; Infant Mortality; Infant, Newborn; Male; Medical sciences; North America; Pneumology; Postoperative Complications - etiology; Postoperative Complications - mortality; Postoperative Complications - surgery; Registries; Risk Assessment; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Time Factors; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; North America; Society of Thoracic Surgeons; 35; STS; aortic valve replacement; AVR; 20; Human; Congenital; Infant; Replacement; Thorax; Cardiac surgery; Surgeon; Newborn; Analysis; Database; Anesthesia; Circulatory system; Society; Cardiology; Aortic valve
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2012.07.060

Objective We sought to describe early outcomes of aortic valve replacement in neonates and infants across a large multicenter cohort. Methods Neonates and infants in the Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing nontruncal aortic valve replacement with the Ross-Konno procedure, Ross procedure, or homograft replacement from 2000 to 2009 were included. Preoperative characteristics, operative data, and early outcomes are described. Results A total of 160 patients (43 neonates, 117 infants) from 47 centers were included. Society of Thoracic Surgeons–defined preoperative risk factors were present in 76 patients (48%) and were most prevalent in neonates (67%) and patients undergoing homograft aortic valve replacement (93%). Concomitant arch repair or mitral valve surgery was performed in 30 patients (19%) and 19 patients (12%), respectively. Postoperative mechanical circulatory support was used in 17 patients (11%). Overall in-hospital mortality was 18% and was highest for neonates (28%) and patients undergoing homograft aortic valve replacement (40%). Concomitant arch repair was associated with higher in-hospital mortality (33% vs 15%, P  = .02), whereas concurrent mitral valve surgery was not (21% vs 18%, P  = .73). Postoperative mechanical circulatory support was also associated with increased in-hospital mortality (65% vs 13%, P  < .0001). Conclusions Neonates and infants undergoing aortic valve replacement are a high-risk group, with hospital mortality comparable with some of the highest risk procedures in this age group. The requirement for arch repair or postoperative mechanical circulatory support was associated with an increased risk of death in this cohort.