Redo aortic valve replacement in children.

Background. Some children who have had an aortic valve replacement ( AVR) will need valve re-replacement ( redo-AVR). We analyzed our results with 38 redo-AVRs in 30 children. Methods. Thirty children, aged 2 months to 20 years ( mean, 11.5 +/- 5.4 years), underwent 38 redo-AVRs 1 month to 14 years ( mean, 4.6 +/- 4.5 years) after previous AVR. Seven children had a second redo-AVR and one had a third redo-AVR ( his fourth AVR). Reoperation indication was primarily stenosis in 19, regurgitation in 12, endocarditis in 3, valve thrombosis-emboli in 3, and ruptured aortic aneurysm in 1. The initial valve was mechanical in 26, homograft in 7, xenograft in 4, or a Ross procedure in 1. Sixteen patients ( 42%) had a previous Konno procedure. Results. The new valve was mechanical ( 28), homograft ( 5), xenograft ( 4), or a Ross procedure ( 1). Twenty-five valves were upsized on re-replacement. The median valve size was 23 mm ( median size increase 4 mm). Twenty-seven operations ( 71%) included annulus enlargement ( 16 redo-Konno, 8 new Konno, and 3 Manougian). Twelve children ( 32%) had concomitant operations including mitral valve repair-replacement ( 4) and right ventricular outflow tract procedure ( 5). Three of the 4 hospital deaths were with second or third time redo-AVR. The only death in patients with first time redo-AVR was a patient in cardiogenic shock at the time of operation. Conclusions. Redo-AVR in children can be performed with reasonable morbidity and mortality. A larger prosthesis can often be placed in these children. Second or third time redo-AVR appears to be riskier. Earlier referral before onset of ventricular dysfunction is warranted.