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Valve-sparing aortic root reconstruction in children, teenagers, and young adults. Ann Thorac Surg 2012 Aug;94(2):587-90; discussion 590-1

Date

07/04/2012

Pubmed ID

22748646

DOI

10.1016/j.athoracsur.2011.12.097

Scopus ID

2-s2.0-84864186345   10 Citations

Abstract

BACKGROUND: We reviewed our experience with valve-sparing aortic root reconstruction (VSARR) using the sinus of Valsalva graft in children, teenagers, and young adults with connective tissue disorders.

METHODS: Results of a single-center experience with VSARR in children, teenagers, and young adults were retrospectively analyzed. End points were death, freedom from reintervention, and freedom from valve dysfunction.

RESULTS: Between 2003 and 2010, 16 patients (Marfan, 9; Loeys Dietz syndrome, 6; conotruncal, 1) underwent VSARR. The mean age was 20±7.4 (range, 9 to 36 years). Indications for VSAAR were aortic root enlargement in 14 (sinus of Valsalva Z-score, 6.2±2) and aortic dissection in 2. Additional procedures included replacement of the ascending aorta in 7, with additional replacement of the aortic arch in 2. No early or late deaths occurred. One patient required a pacemaker. One patient with Loeys-Dietz syndrome required reoperation for aneurysmal dilatation of the coronary buttons. Two patients underwent replacement of the thoracoabdominal aorta for chronic dissection. Follow-up by echocardiography or magnetic resonance imaging at a mean of 33±29 months showed more than mild aortic regurgitation in 2 patients. Both patients with moderate aortic insufficiency also had a bicuspid aortic valve.

CONCLUSIONS: VSARR using the sinus of Valsalva graft is a reproducible technique that achieves acceptable early and intermediate results. It is suitable for children, teenagers, and young adults. Anticoagulation is avoided. The procedure is appropriate for emergency operations but should be used with caution in patients with a bicuspid aortic valve.

Author List

Tweddell JS, Earing MG, Bartz PJ, Dunham-Ingles JL, Woods RK, Mitchell ME

Authors

Peter J. Bartz MD Professor in the Pediatrics department at Medical College of Wisconsin
Michael Edward Mitchell MD Professor in the Surgery department at Medical College of Wisconsin
Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aortic Valve
Cardiac Surgical Procedures
Child
Dilatation, Pathologic
Female
Heart Valve Diseases
Humans
Male
Retrospective Studies
Sinus of Valsalva
Young Adult
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a