Results of aortic valve replacement in children and adolescents with congenital aortic valve lesions
Aim of the study - to evaluate immediate and long-term results of aortic valve (AV) replacement in children and adolescents with congenital AV lesions. Materials and methods. Retrospective study of 221 children aged 3-15 years, operated in 2005-2018 for congenital aortic valve desease; 45 of them had previous AV-intervention (balloon valvuloplasty - 32, AV reconstruction - 13). According to valve pathology, all patients were divided on to 3 gropes: 1st - AV stenosis (n=53, mean age 12.4±2.5 y.o.), AV insufficiency (n=76, mean age 10.6±3.0 y.o.), stenosis + insufficiency (n=92, mean age 11.8±2.8 y.o.). In all patients mechanical were implanted: tilting-disc - 72 (32.6%), bileaflet - 149 (67.4%). Surgery was performed through median sternotomy with moderate hyperemia in 72 (32.6%) patients. Root enlargement technic was used in 71 (32.1%) patient tilting-disk type valves were implanted, bileaflet valves were used in other 149 cases. Results. In-hospital mortality was 2.7% (6 patient). Risk factor for early mortality was surgery before 2010, and younger age. In-hospital stay time was 14.5±3.2, 13.3±4.0 and 13.8±3.7 days (р=0,557). Peak gradient at discharge was 20.6±7.1 mm Hg. Follow-up was complete in 154 (71.6%) patients. Mean follow-up time was 4 (1-13) years. 4 patients died. Increasing of systolic gradient of different degree was observed in all patients. Factors associated with gradient incensement were tilting-disk valve, and low orifice/body surface area (BSA) ratio (less then 1.5± 0.4). 27 (17.5%) patients required reoperation. Cumulative freedom from second surgery was 83% in 5, and 61% in 10 years. Mitral valve (MV) insuuficiensy development was significantly higher in patients, in whom root enlargement had being applied, but only 2 of them needed isolated MV-surgery Conclusion. Mechanical prosthesis for AV substitute in children and adolescents bears tolerable immediate and lion-term outcome. Negative factors, associated with worse outcome are tilting-disc valves and low prosthesis/BSA ratio. Aortic root enlargement appears to be the risk factor for MV regurgitauon development lately after surgery.