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DOI: 10.1055/s-2004-816742
Aortic valve replacement in infants and children: Artificial prostheses or Ross procedure
Objectives: Aortic valve replacement (AVR) can be performed using artificial prostheses or an pulmonary autograft (Ross procedure). We present our results of this different therapeutic options in infants and children.
Methods: Between 1996 and 2003 we performed AVR in 67 patients. In 23 patients (group A) (male: 14, female: 9, mean age: 13 years) we used in 25 procedures an artificial prostheses (mechanical: 20, biological: 2 stented, 3 stentless). From 1998 till 2003 we performed a Ross procedure (group B) in 44 infants and children (male: 34, female: 10, age: mean:10 years, range: 20days-22years). Concommitant procedures done in group B: Konno (n=8), subvalvular myectomia (n=5), sinus valsalva reconstruction (n=2), arteriell switch (n=1), Konno and aorta ascendens replacement (n=1), Konno and bilateral patch plasty of the PA,VSD closure (n=1).
Results: The 30-day mortality was 0 in group A and 4.5% in group B (emergent therapy after BVP (n=1), uncontrolable bleeding in fifth reoperation). During a follow-up period up to 7 years in group A in 5 cases (21.7%) a reoperation has to be done. In group B till now no reoperation of the autograft was performed.4 reoperations in pulmonalis position were mandatory (2 aortic homograft,2 xenografts). The mortality of the redo procedures was 0. The mean gradient of the valves was 32mmHg in groupA. The degree of aortic insufficiency was none in 24, trivial in 19 and severe in 1 case in groupB. In order to prevent thrombembolism in group A anticoagulants (n=20) or aspirin (n=3) was given. None of these drugs were given in groupB.
Conclusions: We prefere Ross procedure because the results are comparable to those of artificial valve replacement. The treatment of LVOT obstruction is superior in Ross procedure. The quality of life is better due to no anticoagulation and reduced risk of endocarditis.