Abstract
Aim of the study: to estimate immediate and mid-term results aortic valve (AV) replacement in children with
congenital AV stenosis.
Material and methods. Retrospective review of 104 consecutive patients aged 5 to 15 years with congenital
AV stenosis and no significant AV insufficiency operated in 2007-2010. According to age, all patients were
divided into two groups: 1st (n=27) – children aged ≤10 years, 2nd – children aged >10 years (n=77). Mean
age was 8.4±1.8 and 13.4±1.2 years. Peak systolic gradient was 75.5±22.4 and 74.5±23.0 mm Hg (p=0.143).
AV annular diameter was 19.2±2.9 and 21.9±1.4 mm.
In the 1st group balloon valvuloplasty was previously performed in 7 (25.9%) patients, and AV reconstruction
in 2 (7.4%). In the 2nd group, 9 (11.7%) patients had valvuloplasty and 4 (5.2%) patients had AV reconstruction.
Mean interval after procedure was 6.1±2.4 and 9.2±2.6 years respectively.
All surgery was performed according to standard protocol with cardiopulmonary bypass and moderate
hypothermia. Aortic annulus enlargement was carried out 18 (66.7%) patients of the 1st group, and in 35
(45.5%) patients of the 2nd. Mechanical valves were used in all patients. Mean size of the implanted valve
was 21±2 mm, and 22±1 mm (p=0.001), valve orifice to body surface area (BSA) ratio was 2.3±0.5 and
1.7±0.3 (p=0.0001).
Results. In-hospital mortality was 11.1% (n=3) in the 1st group and 2.6% (n=2) in the 2nd (p=0.0001). The
reason of adverse outcome was acute heart failure. Non-lethal complication was mostly pericardial effusion.
Mean in-hospital stay (after surgery) was 16.7±9.6 and 13.2±5.6 days (p=0.09). Peak gradient at discharge
was 18.1±5.1 and 22.0±8.6 mm Hg. In both groups factors associated with higher gradients were tilting-disk
type valve and low valve/BSA ratio.
Follow-up was complete in 52% (n=14) and 51% (n=40) of cases. Median follow-up time was 3.5 (2–10)
and 2.5 (0.5–11) years. There were no late deaths. Cumulative freedom from reoperation in 5 years was
100 and 66% (p=0.001) in 10 years – 50 and 49% (p=0.09).
Conclusion. Implantation of mechanical prosthesis in children with congenital AV stenosis in accompanied
by an acceptable immediate outcome. In children less than 10 years significantly higher level of in-hospital
mortality is observed. Low prosthesis/BSA ratio is a risk factor for reoperation within 5 years after surgery.
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About the authors
- Podzolkov Vladimir Petrovich, Dr. Med. Sc., Professor, Academician of Russian Academy of Sciences, Chief of Department; orcid.org/0000-0002-2863-2072
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Samsonov Viktor Borisovich, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0002-6477-7914
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Mataev Viktor Sergeevich, Cand. Med. Sc., Researcher; orcid.org/0000-0003-4386-1233
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Gadzhieva Abidat Shamilovna, Postgraduate; orcid.org/0000-0001-7836-4208
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Dontsova Vera Ivanovna, Cand. Med. Sc., Specialist in Ultrasound Diagnostics;
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Medvedeva Ol'ga Izrailevna, Dr. Med. Sc., Deputy Chief of Medical Work; orcid.org/0000-0002-5381-2921
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Astrakhantseva Tat'yana Olegovna, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0002-8393-0275
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Danilov Timur Yur'evich, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0002-9409-3230
