AORTIC-VALVE REPLACEMENT IN CHILDREN

From January 1970 to January 1993, 47 aortic valve replacements have b een performed in children aged 166.8 +/- 50 months. The valvular patho logy was congenital in 39 patients and associated cardiac anomalies we re present in 31 cases. 30 children had a previous surgical procedure on the aortic outflow. Seven bioprosthesis and 40 mechanical valves ha ve been implanted. At the time of surgery, an additional major cardiac correction has been performed on 17 occasions (Konno, Bentall, Fontan , correction of truncus arteriosus etc.). While no death occurred in t he group subjected only to aortic valve replacement, 7 of the 17 patie nts where a major cardiac procedure was added died. During a mean foll ow-up of 61.2 +/- 59.1 months, 3 late deaths occurred, 2 of them non r elated to valvular surgery. Three reoperations have been performed, in two instances for replacing a degenerated bioprosthesis. One thromboe mbolic event occurred as well as one temporary episode of haemolytic a nemia. No haemorrhagic complication has been observed. While the resul ts of isolated aortic valve replacement in children are excellent, the risk for hospital death is increased substantially when a major cardi ovascular procedure is added to valve replacement, and because of rapi d deterioration, the heterografts are now contra-indicated in children .