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Aortic Valve Surgery in the Pediatric Population

  • Cardiology (W Lai and W Zuckerman, Section Editors)
  • Published:
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Abstract

Purpose of Review

In this paper, current approaches to pediatric aortic valve surgery are discussed.

Recent Findings

While many pediatric aortic valve operations are palliative until an adult-sized prosthetic can fit, some recent advances in adult aortic valve repair techniques can be applied to the pediatric population yielding more definitive repair. Systematic analysis of the valve pathology is necessary to decide on the appropriate operation and refer patients to surgeons with the appropriate expertise.

Summary

The Ross operation remains an ideal operation for pediatric patients with significant aortic valve disease and a competent pulmonic valve, given that it allows the autograft to grow with the child. Depending on aortic valve pathology, those with regurgitation secondary to aneurysmal dilation of the aorta may be candidates for various valve-sparing techniques. Critical congenital aortic stenosis may be managed via balloon valvuloplasty or surgical valvotomy depending on the specific scenario. Valve replacement is not ideal in the pediatric population, particularly if the patient is not full-grown, but can be necessary.

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References

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  1. Sundt TM, Moon MR, Xu H. Reoperation for dilatation of the pulmonary autograft after the Ross procedure. J Thorac Cardiovasc Surg. 2001;122:1249–52.

    Article  CAS  PubMed  Google Scholar 

  2. Leyh RG, Kofidis T, Fischer S, Kallenbach K, Harringer W, Haverich A. Aortic root reimplantation for successful repair of an insufficient pulmonary autograft valve after the Ross procedure. J Thorac Cardiovasc Surg. 2002;124:1048–9.

    Article  PubMed  Google Scholar 

  3. Masetti P, Davila-Roman VA, Kouchoukos NT. Valve-sparing procedure for dilatation of the autologous pulmonary artery and ascending aorta after the Ross operation. Ann Thorac Surg. 2003;76:915–6.

    Article  PubMed  Google Scholar 

  4. El-Essawi A, Sanger J, Ulrich S, Kutschka I, Harringer W. Aortic valve-sparing operation for autograft failure after the Ross procedure. J Thorac Cardiovasc Surg. 2005;130:1215–6.

    Article  PubMed  Google Scholar 

  5. Ross DN. Replacement of aortic and mitral valves with a pulmonary autograft. Lancet. 1967;2:956–8.

    Article  CAS  PubMed  Google Scholar 

  6. Woods RK, et al. Aortic valve replacement in neonates and infants: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg. 2012;144:1084–9.

    Article  PubMed  Google Scholar 

  7. El-Hamamsy I, Yacoub MH. Repair, replacement, Ross: how I approach the older child with mixed aortic stenosis/aortic insufficiency. Seminars in thoracic and cardiovascular surgery: Pediatric cardiac surgery annual. 2009:133–8.

  8. •• David TE, David C, Woo A, Manlhiot C. The Ross procedure: outcomes at 20 years. J Thorac Cardiovasc Surg. 2014;147:85–93. Excellent summary of Ross operation in an expert’s hands.

    Article  PubMed  Google Scholar 

  9. Sievers HH, et al. Fourteen years’ experience with 501 subcoronary Ross procedures: surgical details and results. J Thorac Cardiovasc Surg. 2010;140:816–22. 822 e1-5

    Article  PubMed  Google Scholar 

  10. Elkins RC, Knott-Craig CJ, Ward KE, Lane MM. The Ross operation in children: 10-year experience. Ann Thorac Surg. 1998;65:496–502.

    Article  CAS  PubMed  Google Scholar 

  11. Lupinetti FM, Duncan BW, Lewin M, Dyamenahalli U, Rosenthal GL. Comparison of autograft and allograft aortic valve replacement in children. J Thorac Cardiovasc Surg. 2003;126:240–6.

    Article  PubMed  Google Scholar 

  12. Laudito A, et al. The Ross procedure in children and young adults: a word of caution. J Thorac Cardiovasc Surg. 2001;122:147–53.

    Article  CAS  PubMed  Google Scholar 

  13. Turrentine MW, Ruzmetov M, Vijay P, Bills RG, Brown JW. Biological versus mechanical aortic valve replacement in children. Ann Thorac Surg. 2001;71:S356–60.

    Article  CAS  PubMed  Google Scholar 

  14. Hraska V, et al. Ross and Ross-Konno procedure in children and adolescents: mid-term results. Eur J Cardiothorac Surg. 2004;25:742–7.

    Article  CAS  PubMed  Google Scholar 

  15. El-Hamamsy I, et al. Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: a randomised controlled trial. Lancet. 2010;376:524–31.

    Article  PubMed  Google Scholar 

  16. Andreas M, et al. The Ross procedure offers excellent survival compared with mechanical aortic valve replacement in a real-world setting. Eur J Cardiothorac Surg. 2014;46:409–13. discussion 413-4

    Article  PubMed  Google Scholar 

  17. Brown JW, Ruzmetov M, Rodefeld MD, Mahomed Y, Turrentine MW. Incidence of and risk factors for pulmonary autograft dilation after Ross aortic valve replacement. Ann Thorac Surg. 2007;83:1781–7. discussion 1787-9

    Article  PubMed  Google Scholar 

  18. Simon-Kupilik N, et al. Dilatation of the autograft root after the Ross operation. Eur J Cardiothorac Surg. 2002;21:470–3.

    Article  PubMed  Google Scholar 

  19. Sievers HH, et al. Major adverse cardiac and cerebrovascular events after the Ross procedure: a report from the German-Dutch Ross Registry. Circulation. 2010;122:S216–23.

    Article  PubMed  Google Scholar 

  20. Slater M, Shen I, Welke K, Komanapalli C and Ungerleider R. Modification to the Ross procedure to prevent autograft dilatation. Seminars in thoracic and cardiovascular surgery: Pediatric cardiac surgery annual. 2005;181–4.

  21. Ungerleider RM, Ootaki Y, Shen I, Welke KF. Modified Ross procedure to prevent autograft dilatation. Ann Thorac Surg. 2010;90:1035–7. discussion 1037

    Article  PubMed  Google Scholar 

  22. Juthier F, et al. Modified Ross operation with reinforcement of the pulmonary autograft: six-year results. J Thorac Cardiovasc Surg. 2010;139:1420–3.

    Article  PubMed  Google Scholar 

  23. Gebauer R, Cerny S. A modification of the Ross procedure to prevent pulmonary autograft dilatation. Eur J Cardiothorac Surg. 2009;36:195–7.

    Article  PubMed  Google Scholar 

  24. Brown JW, Ruzmetov M, Shahriari AP, Rodefeld MD, Mahomed Y, Turrentine MW. Modification of the Ross aortic valve replacement to prevent late autograft dilatation. Eur J Cardiothorac Surg. 2010;37:1002–7.

    Article  PubMed  Google Scholar 

  25. Al Rashidi F, Bhat M, Hoglund P, Meurling C, Roijer A, Koul B. The modified Ross operation using a Dacron prosthetic vascular jacket does prevent pulmonary autograft dilatation at 4.5-year follow-up. Eur J Cardiothorac Surg. 2010;37:928–33.

    Article  PubMed  Google Scholar 

  26. David TE, Woo A, Armstrong S, Maganti M. When is the Ross operation a good option to treat aortic valve disease? J Thorac Cardiovasc Surg. 2010;139:68–75.

    Article  PubMed  Google Scholar 

  27. Gillespie MJ, et al. Transcatheter pulmonary valve replacement for right ventricular outflow tract conduit dysfunction after the Ross procedure. Ann Thorac Surg. 2015;100:996–1003.

    Article  PubMed  Google Scholar 

  28. El Khoury G, et al. Functional classification of aortic root/valve abnormalities and their correlation with etiologies and surgical procedures. Curr Opin Cardiol. 2005;20:115–21.

    Article  CAS  PubMed  Google Scholar 

  29. Boodhwani M, et al. Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg. 2009;137:286–94.

    Article  PubMed  Google Scholar 

  30. Kunihara T, et al. Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair. J Thorac Cardiovasc Surg. 2012;143:1389–95.

    Article  PubMed  Google Scholar 

  31. Pethig K, Milz A, Hagl C, Harringer W, Haverich A. Aortic valve reimplantation in ascending aortic aneurysm: risk factors for early valve failure. Ann Thorac Surg. 2002;73:29–33.

    Article  PubMed  Google Scholar 

  32. Grinda JM, et al. Aortic cusp extension valvuloplasty for rheumatic aortic valve disease: midterm results. Ann Thorac Surg. 2002;74:438–43.

    Article  PubMed  Google Scholar 

  33. Al Halees Z, Al Shahid M, Al Sanei A, Sallehuddin A, Duran C. Up to 16 years follow-up of aortic valve reconstruction with pericardium: a stentless readily available cheap valve? Eur J Cardiothorac Surg. 2005;28:200–5. discussion 205

    Article  PubMed  Google Scholar 

  34. McCrindle BW, et al. Are outcomes of surgical versus transcatheter balloon valvotomy equivalent in neonatal critical aortic stenosis? Circulation. 2001;104:I152–8.

    Article  CAS  PubMed  Google Scholar 

  35. Brown JW, Rodefeld MD, Ruzmetov M, Eltayeb O, Yurdakok O, Turrentine MW. Surgical valvuloplasty versus balloon aortic dilation for congenital aortic stenosis: are evidence-based outcomes relevant? Ann Thorac Surg. 2012;94:146–53. discussion 153-5

    Article  PubMed  Google Scholar 

  36. Karamlou T, et al. The influence of valve physiology on outcome following aortic valvotomy for congenital bicuspid valve in children: 30-year results from a single institution. Eur J Cardiothorac Surg. 2005;27:81–5.

    Article  PubMed  Google Scholar 

  37. Balmer C, Beghetti M, Fasnacht M, Friedli B, Arbenz U. Balloon aortic valvoplasty in paediatric patients: progressive aortic regurgitation is common. Heart. 2004;90:77–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Keane JF, et al. Second natural history study of congenital heart defects. Results of treatment of patients with aortic valvar stenosis. Circulation. 1993;87:I16–27.

    CAS  PubMed  Google Scholar 

  39. Maskatia SA, et al. Twenty-five year experience with balloon aortic valvuloplasty for congenital aortic stenosis. Am J Cardiol. 2011;108:1024–8.

    Article  PubMed  Google Scholar 

  40. Brown DW, Dipilato AE, Chong EC, Lock JE, McElhinney DB. Aortic valve reinterventions after balloon aortic valvuloplasty for congenital aortic stenosis intermediate and late follow-up. J Am Coll Cardiol. 2010;56:1740–9.

    Article  PubMed  Google Scholar 

  41. • Torres A, et al. Balloon valvuloplasty for congenital aortic stenosis: multi-center safety and efficacy outcome assessment. Catheter Cardiovasc Interv. 2015;86:808–20. Excellent study of results of balloon valvuloplasty for congenital aortic stenosis

    Article  PubMed  Google Scholar 

  42. Hraska V, et al. The long-term outcome of open valvotomy for critical aortic stenosis in neonates. Ann Thorac Surg. 2012;94:1519–26.

    Article  PubMed  Google Scholar 

  43. Alexiou C, et al. Open commissurotomy for critical isolated aortic stenosis in neonates. Ann Thorac Surg. 2001;71:489–93.

    Article  CAS  PubMed  Google Scholar 

  44. Reich O, et al. Long term results of percutaneous balloon valvoplasty of congenital aortic stenosis: independent predictors of outcome. Heart. 2004;90:70–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Thomson JD. Management of valvar aortic stenosis in children. Heart. 2004;90:5–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. American College of Cardiology/American Heart Association Task Force on Practice G, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006;114:e84–231.

    Article  Google Scholar 

  47. Hiratzka LF, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121:e266–369.

    Article  PubMed  Google Scholar 

  48. Nishimura RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014;148:e1–e132.

    Article  PubMed  Google Scholar 

  49. Erbel R, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2873–926.

    Article  PubMed  Google Scholar 

  50. Girdauskas E, Disha K, Raisin HH, Secknus MA, Borger MA, Kuntze T. Risk of late aortic events after an isolated aortic valve replacement for bicuspid aortic valve stenosis with concomitant ascending aortic dilation. Eur J Cardiothorac Surg. 2012;42:832–7. discussion 837-8

    Article  PubMed  Google Scholar 

  51. Girdauskas E, Disha K, Secknus M, Borger M, Kuntze T. Increased risk of late aortic events after isolated aortic valve replacement in patients with bicuspid aortic valve insufficiency versus stenosis. J Cardiovasc Surg. 2013;54:653–9.

    CAS  Google Scholar 

  52. Kadri MA, Hovaguimian H, Starr A. Commissurotomy and bileaflet pericardial augmentation-resuspension for bicuspid aortic valve stenosis. Ann Thorac Surg. 1997;63:548–50.

    Article  CAS  PubMed  Google Scholar 

  53. Tolan MJ, Daubeney PE, Slavik Z, Keeton BR, Salmon AP, Monro JL. Aortic valve repair of congenital stenosis with bovine pericardium. Ann Thorac Surg. 1997;63:465–9.

    Article  CAS  PubMed  Google Scholar 

  54. Tweddell JS, et al. Aortic valve repair. Seminars in thoracic and cardiovascular surgery: Pediatric cardiac surgery annual. 2005:112–21.

  55. Ozaki S, et al. Aortic valve reconstruction using autologous pericardium for aortic stenosis. Circ J. 2015;79:1504–10.

    Article  PubMed  Google Scholar 

  56. Lubiszewska B, et al. Mechanical valve replacement in congenital heart disease in children. J Heart Valve Dis. 1999;8:74–9.

    CAS  PubMed  Google Scholar 

  57. Alexiou C, McDonald A, Langley SM, Dalrymple-Hay MJ, Haw MP, Monro JL. Aortic valve replacement in children: are mechanical prostheses a good option? Eur J Cardiothorac Surg. 2000;17:125–33.

    Article  CAS  PubMed  Google Scholar 

  58. Champsaur G, et al. Mechanical valve in aortic position is a valid option in children and adolescents. Eur J Cardiothorac Surg. 1997;11:117–22.

    Article  CAS  PubMed  Google Scholar 

  59. Shanmugam G, MacArthur K, Pollock J. Mechanical aortic valve replacement: long-term outcomes in children. J Heart Valve Dis. 2005;14:166–71.

    PubMed  Google Scholar 

  60. Fioretta ES, Dijkman PE, Emmert MY, Hoerstrup SP. The future of heart valve replacement: recent developments and translational challenges for heart valve tissue engineering. J Tissue Eng Regen Med. 2016;

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Correspondence to Elizabeth H. Stephens.

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Elizabeth H. Stephens and Paul Chai each declare no potential conflicts of interest.

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Stephens, E.H., Chai, P. Aortic Valve Surgery in the Pediatric Population. Curr Pediatr Rep 5, 64–72 (2017). https://doi.org/10.1007/s40124-017-0128-5

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  • DOI: https://doi.org/10.1007/s40124-017-0128-5

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