SMALL AORTIC ROOT IN CHILDHOOD - SURGICAL OPTIONS

Aortic valve replacement in the pediatric population is complicated by the often complex nature of the left ventricular outflow tract obstru ction. Techniques to enlarge the annulus frequently are necessary. Fro m 1977 to 1991, 32 children underwent an annular enlargement procedure at The Hospital for Sick Children, Toronto. During this same era, 110 children underwent a total of 138 aortic valve replacements. Eleven h ad the annulus enlarged with a posterior patch technique and implantat ion of a valve (mechanical 8, porcine heterograft 2, homograft 1) rang ing from 20 to 25 mm in diameter. Twenty-two children had an anterior annular enlargement (aortoventriculoplasty) and aortic valve replaceme nt with a valve (mechanical 8, porcine 2, homograft 12) 12 to 27 mm in diameter. One child had a posterior patch enlargement performed, foll owed by a second operation involving anterior annular enlargement. The re was one early death in the posterior annuloplasty group and one lat e death due to failure of a bioprosthetic valve. There were five hospi tal deaths in the anterior annuloplasty group (22%; 70% confidence int erval [CI], 14% to 32%) and two late deaths. Actuarial survival for th e 32 children was 78% (70% CI, 70% to 86%) at 5 years and 65% (70% CI, 48% to 82%) at 10 years after repair. Younger children (age less than 1 year) had a significantly worse survival at 5 years (33%; 70% CI, 1 4% to 52%) than older children (88%; 70% CI, 82% to 95%). The survivor s are well, and no reoperations have been necessary because of the chi ldren's outgrowing their valve.