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Stephen M. Cattaneo
Brian T. Bethea
Diane E. Alejo
Vincent L. Gott
Duke E. Cameron
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Ann Thorac Surg 2004;77:168-176
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Surgery for aortic root aneurysm in children: a 21-Year experience in 50 patients

Stephen M. Cattaneo, MDa, Brian T. Bethea, MDa, Diane E. Alejo, BAa, Philip J. Spevak, MDb, Sarah B. Clauss, MDb, Harry C. Dietz, MDb,c, Vincent L. Gott, MDa*, Duke E. Cameron, MDa

a Division of Cardiac Surgery Baltimore, MD, USA
b Division of Pediatric Cardiology,Baltimore, MD, USA Institute of Genetic Medicine
c Howard Hughes Medical Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

Accepted for publication July 21, 2003.

* Address reprint requests to Dr Gott, 618 Blalock Building, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287, USA
e-mail: vgott{at}csurg.jhmi.jhu.edu

Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.

BACKGROUND: Ascending aortic aneurysms are unusual in children and have received little attention to develop guidelines for management. This study reviewed our experience with 50 children who have undergone aortic root replacement for ascending aortic aneurysm.

METHODS: A retrospective clinical review was conducted using hospital charts and office records. Patients or their physicians were contacted for follow-up and recent echocardiograms were obtained and reviewed.

RESULTS: There was no operative or hospital mortality. Twenty-six children had aortic root replacement with a composite graft, 10 patients had replacement with a homograft aortic root, and 14 patients had a David II valve-sparing procedure. Factors related to late morbidity and mortality were analyzed. Long-term results were excellent in the 26 children receiving a composite graft. Twenty-three of these children were New York Heart Association class I (19) or II (4) at study closure. There were 3 late deaths (11, 16, and 17 years postoperative). Seven of 10 children receiving a homograft aortic root are long-term survivors and all 14 children having a valve-sparing procedure are alive. Generally, late results with the David II remodeling procedure have been good although 3 patients developed late aortic insufficiency and two required valve replacement.

CONCLUSIONS: Aortic root replacement in children with aneurysms has low operative risk and good long-term results. Composite grafts in particular carry a low risk of endocarditis, thromboembolism, and hemorrhagic events. Homografts are suitable for small patients but lack durability. Late results with the David II remodeling valve-sparing procedure in children have been compromised by late root dilatation.




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