BACKGROUND: Valve replacement options are limited in children. Can complex valve repair provide a durable and effective option?
METHODS:Retrospective review of surgery for aortic valve disease(1973-2003).
RESULTS:In 278 patients with aortic valve disease, 101 pts. required either valve replacement (AVR) or complex repair. Primary diagnosis was AS(35%), AI(46%) or combined AS/AI(19%). AVR was performed in 48 using mechanical(n=22), homograft(n=9), or autograft(n=17) valves. Complex repairs(n=53) included commissurotomy and additional surgical techniques including leaflet thinning(17), suspension(21), extension(6), fenestration repair(9), supravalvar augmentation(8) or relief of subAS(10). Actuarial freedom from mortality or reintervention for all was: 1yr-90±3%, 5yrs-77±6%, and 10yrs-51±10%. Comparing the group undergoing valve repair to those with AVR, repair patients were younger(9.9±8.1 vs. 14±7.2yrs), more likely to have AS as their primary diagnosis(49% vs. 19%), and had higher preoperative gradients across the valve(75±23 vs. 49±31mmHg), all p<.05. Presence of combined AS/AI did not predict poor outcome. On follow-up ECHO at a mean duration of 3.2yrs post-repair, valve repair pts. had a mean gradient of 20±19mmHg and 87% had mild or less AI. Operative survival was 100% for valve repair compared to 88.7% for AVR(p<.05). Actuarial freedom from mortality or reintervention was not different between groups(p=.59); at 5yrs post-op, valve repair-79±8% vs. AVR-75±9%.
CONCLUSIONS:Intermediate follow-up in pts. undergoing aortic valve repair indicates this is an option for children with aortic valve disease, including those with mixed AS/AI. Repair is advantageous because it alleviates need for long-term anticoagulation, maintains growth potential of the aortic root and delays valve replacement. Furthermore, the autograft option remains open.

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