Aortic Valve Repair for Pediatric and Grown-Up Congenital Heart Disease Patients: 16 Years Single-Center Experience with 106 Cases

Objective: This study aims to analyze our results of aortic valve (AV) repair in pediatric and adult patients with congenital heart disease (GUCH). Primary end points were overall survival, need for AV repair reoperation, and AV replacement.

Methods: Between 2002 and 2018, 106 patients received AV repair. Ninety patients were under 18 years and 16 patients were GUCH patients. Median age of operation was 11.2 years (1 day–32.6 years). Neonatal repair was performed in 6 patients, and infantile repair was also performed in 17 patients. Thirty-one patients had simple repair (commissurotomy, leaflet shaving) and 75 patients underwent complex repair (leaflet plication, leaflet repair, cusp extension-augmentation, and sinus valsalva–annulus reduction). Indications of surgery were aortic stenosis (AS) in 49 patients (46.3%), aortic regurgitation (AI) in 29 patients (27.3%), and mixed disease in 28 patients (26.4%). Thirty-seven patients (34.5%) had previously different cardiac operation before AV repair. During AV repair, additional cardiac procedures were performed in 53 patients; subaortic ridge resection (n = 17), aortic arch reconstruction (n = 10), mitral valve reconstruction (n = 6), truncus arteriosus communis (TAC) repair (n = 4), and VSD closure (n = 3) were the most frequent additional procedures.

Results: Hospital mortality was seen in two patients (1.8%). Median follow-up of survivors was 37 months (2–188 months). Late mortality was seen in three patients. One of these deaths was cardiac related. During follow-up period, 30 patients (30%) needed AV reoperations. Out of these 30 patients, at the time of first AV repair, 9 patients (30%) had received simple repair and 21 patients (70%) complex repair. Out of 49 patients with preoperative AS, 9 patients underwent reoperation (18%). Out of 29 patients with preoperative AI, 8 patients underwent reoperation (28%). Out of 28 mixed type patients, 13 patients required reoperation (46%). At the reoperation, 9 patients received re-AV repair, 10 patients had AV replacement, 7 patients underwent Ross operation, and 4 patients Ross–Konno operation. Median interval for reoperation was 23.5 months (range: 0.2–180 months).

Conclusion: Early and late mortalities after AV repair are very low despite of associated complex cardiac anomalies, but reoperation rates are high. There was no difference regarding reoperation rate between simple and complex AV repairs. The best results were observed in AS group, whereas the poor outcomes were seen in mixed type group.