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Ann Thorac Surg 1980;29:512-518
© 1980 The Society of Thoracic Surgeons

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Articles

Aortic Valve Replacement in Preteenage Children

Division of Surgery of the Texas Heart Institute of St. Luke's Episcopal and Texas Children's Hospitals, Houston, TX

^* Address reprint requests to Dr. Cooley, Texas Heart Institute, PO Box 20345, Houston, TX 77025

During the last 15 years, 26 children who ranged from 4 to 12 years old underwent sub-coronary aortic valve replacement (AVR) at the Texas Heart Institute. The valve lesions resulted from congenital heart disease in 20 patients, 15 of whom had had a previous operation including 13 aortic valve procedures. Cystic medial necrosis necessitated AVR in 5 patients, all of whom had physical findings of Marfan's syndrome. One patient had rheumatic heart disease and required double-valve (aortic and mitral) replacement. Six different types of prosthesis were used: the Smeloff-Cutter, Starr-Edwards, Cooley-Cutter, Hancock porcine, Ionescu-Shiley, and Björk-Shiley.

The first patient in the series was the only early death (3.8%). Long-term follow-up data ranging from 1 month to 10 years were available on 20 patients. Three late deaths occurred (11.5%). All survivors are doing well and have good exercise tolerance. These data suggest that AVR performed in childhood is a safe, durable, and well-tolerated form of therapy. Later replacement, if necessary, can be accomplished with larger-sized prostheses. Our present choice is the Ionescu-Shiley bovine xenograft because of its superior hemodynamic characteristics and low incidence of embolic complications.

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