Biological versus mechanical aortic valve replacement in children

Background. Aortic valve replacement in children remains challenging becaus e of constraints imposed by available prosthetic devices. Potential risks o f anticoagulation with mechanical valves and degeneration of other biologic al substitutes have kindled interest in the Ross procedure. This study outl ines the evolution of our 27-year experience with prosthetic devices. Methods. Ninety-nine patients who underwent aortic valve replacement (Janua ry 1973 through September 2000) were included in this study. Procedures inc luded implantation of pulmonary autograft (PA) (n = 42), aortic homograft ( AH) (n = 3), mechanical valves (MV) (n = 41), and xenograft tissue valves ( XG) (n = 13). Results. The mean follow-up times were: 3.8 +/- 1.3 years for PA, 3.5 +/- 1 .5 years for AH, 7.7 +/- 4.7 years for MV, and 8.4 +/- 4.8 years for XG. Th ere were no significant differences in perioperative outcomes among the gro ups (p less than or equal to 0.05) or early deaths (2 each in the MV, AH, a nd PA groups). The incidence of valve-related complications and reoperation s was high in the MV (n = 5), XG (n = 7), and AH (n = 1) groups as compared with the PA group (n = 3, p < 0.01). Early and late mortality for the seri es was 8.6% (n = 8). Overall, the reoperation rate was 20.7% (n = 18): 15.2 % (5 of 33) MV, 70% (7 of 10) XG, 50% (1 of 2) AH, and 11.9% (5 of 42) for PA. The actuarial survival rate was 87.8% and 100% at 10 years for MV and X G, and 95.2% and 6.6% at 7 years for PA and AH. Conclusions. Aortic valve replacement in children can be performed with acc eptable mortality and good longterm results. The Ross procedure, although m ore complicated, has the advantage of not requiring anticoagulation therapy , can be performed in all age groups, possesses inherent growth potential, and exhibits the most normal left ventricular outflow tract hemodynamics. ( C) 2001 by The Society of Thoracic Surgeons.