Novel technique of valve-sparing aortic root replacement in two children younger than 3 years of age

State of the Art Review: Aortic Valve Repair in Infants and Children

BACKGROUND

Congenital aortic and truncal valve disease is challenging in infants and children given the lack of available prostheses in very small sizes and the limited durability of homograft aortic valve replacement.

METHODS

A comprehensive literature search was performed using the PubMed database. Studies were included either if the report included patients less than 1 year of age or if the technique was tailored to accommodate for somatic growth.

RESULTS

Techniques for aortic and truncal valve repair addressing each aspect of the aortic valve complex-the aorta, aortic annulus, commissures, and cusps-were reviewed. The incidence of reoperation after aortic or truncal valve repair is significant at 10 years and ranges from 30% to 70% depending on the underlying diagnosis and the repair technique used. A significant challenge in interpreting the published literature relates to the lack of anatomic data available in the publications, thus limiting both the ability to make direct comparisons among operative techniques and the ability to draw conclusions regarding these techniques as applied to varied causes.

CONCLUSIONS

A comprehensive understanding of the aortic valve complex is necessary to achieve adequate results in pediatric aortic valve repair given the high variability in these valves.

Systematic Approach to Aortic Valvuloplasty in Children and Young Adults

Valve repair in children and young adults is an attractive alternative to replacement or Ross procedure. In the past, the various valvuloplasty techniques have addressed isolated valve pathology. Recently, however, a holistic approach involving repair of all aortic root structures has evolved and promised to be an excellent alternative to valve replacement. It provides good long-term results and avoids all the drawback of prosthetic valve insertion in this age group. Development of ideal patch material needed for valve repair and better understanding of the anatomy and function of the aortic root may further improve the short- and long-term outcomes of aortic valvuloplasty.