Valve-sparing aortic root replacement in adult patients with congenital heart disease

Abstract

OBJECTIVES Aortic root dilatation is frequently observed in patients with congenital heart defects (CHD), but has received little attention in terms of developing a best practice approach for treatment. In this study, we analysed our experience with aortic valve-sparing root replacement in patients following previous operations to repair CHD. METHODS In this study, we included 7 patients with a history of previous surgery for CHD who underwent aortic valve-sparing operations. The underlying initial defects were tetralogy of Fallot (n = 3), transposition of great arteries (n = 2), coarctation of the aorta (n = 1), and pulmonary atresia with ventricle septum defect (n = 1). The patients’ age ranged from 20 to 40 years (mean age 31 ± 6 years). RESULTS David reimplantation was performed in 6 patients and a Yacoub remodelling procedure was performed in 1 patient. Four patients underwent simultaneous pulmonary valve replacement. The mean interval between the corrective procedure for CHD and the aortic valve-sparing surgery was 26 ± 3 years. There was no operative or late mortality. The patient with transposition of great arteries following an arterial switch operation was re-operated 25 months after the valve-sparing procedure due to severe aortic regurgitation. In all other patients, the aortic valve regurgitation was mild or negligible at the latest follow-up (mean 8.7 years, range 2.1–15.1 years). CONCLUSIONS Valve-sparing aortic root replacement resulted in good aortic valve function during the first decade of observation in 6 of 7 patients. This approach can offer a viable alternative to root replacement with mechanical or biological prostheses in selected patients following CHD repair.

Simultaneous Aortic and Pulmonary Valve Replacement in Repaired Congenital Heart Disease

“…Therefore, in our opinion, the surgical procedure should be clear and meticulously planned even before the start of extracorporeal circulation. To save time, a safe reconstruction, especially of the aortic valve or root, is preferable; 17 otherwise, valve or root replacement is necessary.…”

“…Therefore, in our opinion, the surgical procedure should be clear and meticulously planned even before the start of extracorporeal circulation. To save time, a safe reconstruction, especially of the aortic valve or root, is preferable [17], otherwise valve or root replacement is necessary. This also needs preoperative discussion of valve selection with patients, their parents, and the colleagues providing further treatment post-operatively.…”