Aortic Valve Replacement with Stentless Bioprosthesis in the Young

  • Guido Michielon, Italy
  • Fiore Iorio, Cardiac Surgery Department Ospedale Pediatrico Bambino Gesù , Roma, Italy
  • Gianluca Oricchio, Cardiac Surgery Department Ospedale Pediatrico Bambino Gesù , Roma, Italy
  • Duccio Di Carlo, Cardiac Surgery Department Ospedale Pediatrico Bambino Gesù , Roma, Italy
  • Gianluca Brancaccio, Cardiac Surgery Department Ospedale Pediatrico Bambino Gesù , Roma, Italy
  • Antonio Amodeo, Cardiac Surgery Department Ospedale Pediatrico Bambino Gesù , Roma, Kenya
  • Giorgia Grutter, Cardiac Surgery Department Ospedale Pediatrico Bambino Gesù , Roma, Italy
  • Roberto Di Donato, Cardiac Surgery Department Ospedale Pediatrico Bambino Gesù , Roma, Italy

    • Objective: Ross operation is a double root procedure widely used in children with aortic valve (AoV) disease. Freedom from autograft and allograft reoperations and long-term durability in patients with bicuspid AoV are still under debate. We report the first preliminary experience with stentless aortic bioprostheses in selected children and adolescents with AoV disease.
    Methods: 25 patients (mean age 16.8+/-8 years) were enrolled in this prospective study between 2003 and 2008. Serial echocardiographic evaluations were available in all. Mean follow-up was 24.2 months.
    Results: Indication for AoV replacement were severe AI in 9 (36%), AS in 6 (24%) and combined AS/AI in 10 (40%). Seventeen patients(68%) had undergone previous cardiac surgery, including AoV plasty in 8 (32%). A bioprosthesis was preferred for pregnancy desire (7), contraindication to anticoagulation (8), and patient’s preference (10). Surgical anatomy included unicuspid AoV (2), bicuspid AoV (14), tricuspid AoV (8) and failed mechanical prosthesis (1). Subcoronary implantation was preferred in 21 (84%). Associated procedures were performed in 9 (36%). Kaplan Meier survival is 95.2+/-4.6% at 64 months. Freedom from thromboembolism, prosthetic endocarditis, structural valve degeneration and reoperation is 100% at 64 months. Freedom from AI is 95.2+/-4.6% at 64 months. Mean transprosthetic gradient within 6 months from surgery is 10.6+/-4.7mmHg. Full recovery of left ventricular function was observed in all. No patient is currently on anticoagulants and one patient delivered full-term without complications.
    Conclusions: AoV replacement with stentless bioprosthesis is safe and may represent a valid alternative to the Ross operation in young selected patients.