Replacement of the Ascending Aorta in Early Childhood: Surgical Strategies and Long-Term Outcome
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1 Replacement of the Ascending Aorta in Early Childhood: Surgical Strategies and Long-Term Outcome Anne Moreau de Bellaing, MD O. Raisky, A. Haydar, D. Bonnet, F. Bajolle!! Unité médico-chirurgicale de Cardiologie Congénitale et Pédiatrique! Hôpital Universitaire Necker Enfants malades APHP, Université Paris Descartes, Sorbonne Paris Cité! IcarP Cardiology, Institut Hospitalo-Universitaire IMAGINE!! Centre de Référence Maladies Rares! Malformations Cardiaques Congénitales Complexes-M3C! Centre de Référence Maladies Rares! Maladies Cardiaques Héréditaires- CARDIOGEN!
2 I have no conflict of interest to declare
3 Background Aortic root dilatation: rare in young children Connective Tissue Diseases Isolated Congenital Heart Diseases
4 Background Ascending Aorta Replacement: surgical techniques Composite graft procedure Valve-sparing procedures Remodeling technique (Yacoub) Reimplantation technique (David) Pictures from Michael Gatzoulis
5 Methods Retrospective study in Necker hospital (Paris, France) between 1995 and 2017 Ascending aorta replacement (AAR): 32 children < 10 year-old Median age : 5.3 years (range, 7 months to 9.7 years) Median weight : 18 kg (range, 5.8 to 55 kg) Main population features n = 22 (69%) had a connective tissue disease n = 7 (22%) had undergone a neonatal surgery including outflow tract (Ross procedure, arterial switch operation,...) n = 10 (31%) associated a bicuspid aortic valve
6 Methods AAR procedures n = 11 composite mechanical valve graft procedures (Bentall operations) n = 21 valve-sparing procedures n = 10 remodeling procedures (Yacoub operations) n = 11 reimplantation procedures (David operations) David Bentall Yacoub
7 Methods-Population AAR procedures n = 11 composite mechanical valve graft repair n = 21 valve-sparing procedures n = 10 remodeling procedure (Yacoub operati Table 1: Patients and operative data according to the ascending aorta procedure n = 11 reimplantation procedure (David operat Table 2: Patients and operative data according to the underlying congenital disease IMS = Infantile Marfan Syndrome, LDS = Loeys-Dietz syndrome, AR = Aortic Regurgitation, ns = no significant
8 Results (1): Mortality No operative death Cardiac-related mortality: n = 2 patients (6%) Related with left ventricular failure 1 patient with a coronary injury during surgery 1 patient with a secondary unexplained dilated cardiomyopathy One-year and ten-year patient survivals: 91% Figure 1: Kaplan-Meier survival after AAR in children < 10 year-old
9 Results (2): Risk factors of Mortality Table 3: Cardiac-related mortality risk factors IMS: Infantile Marfan Syndrome, ns = no significant
10 Results (3): Reintervention n = 29 survivors Median follow-up for survivors = 7.7 years (range, 6 months to 23 years) Reintervention: n = 11 (38%) after a median time of 4.2 years Required by aortic regurgitation after initial valve-sparing procedure One-year and ten-year freedom from reintervention: 96% and 51% Table 4: Surgical and demographic features of the patients who required a reintervention with aortic valve replacement by a mechanical prosthesis IMS: Infantile Marfan Syndrome
11 Results (4): Risk factors of Reintervention Table 5: Reoperation risk factors IMS: Infantile Marfan Syndrome, ns = no significant a/ b/ Figure 1: Kaplan Meier curves according to a/ surgical procedure b/ underlying IMS
12 Conclusions Acceptable long-term outcome, low late mortality Bentall procedure is safe and durable Data would suggest death is related with greater aortic root Zscore Special surgical strategy for IMS with subsequent unavoidable aortic regurgitation
13 Thank you
14 Thank you
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(Ann Thorac Surg 2008;85:845 53)
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