Romaniuk O. Surgical treatment of aortic valve disease in children: pulmonary autograft operation

This Dissertation contains a theoretical substantiation and practical solution for a highly relevant scientific problem in the field of Medicine, that is, surgical treatment of aortic valve (AV) disease in children via a procedure of aortic valve replacement with an autologous pulmonary autograft valve (PAVR, pulmonary autograft valve replacement). This Dissertation is the first Ukrainian research to explore immediate and late outcomes of PAVR operation The study enrolled 151 consecutive patients up to 18 years of age, which had a PAVR procedure between 1996 and 2014. Median patient age was 128 months or 10.7 years (range: 13 days to 18 years); median body weight was 35.5 kg (3.3 to 94 kg). The indications to PAVR included aortic insufficiency in 68 patients (45%), aortic stenosis in 68 (45%) patients and complex AV disease in 15 (10%) patients. Congenital AV disease was present in 127 (85%) patients; 13 (8.6%) patients presented with a rheumatic heart disease and 5 (3.3%) patients had endocarditis. Were developed new surgical modifications of the PAVR operation - autograft root reinforcement and techniques the neoPA reconstruction. Modified PAVR operation included: 1) external reinforcement of the pulmonary autograft (non-coronary and parts of the coronary sinuses) with aortic wall remains; 2) a double suture of proximal and distal anastomosis in the implantation of an autograft; 3) modifications of PA reconstruction. Modified PAVR procedure was used in 82 patients (54,3%) (group I), in 69 patients – non-modified PAVR operation (group II). For PA reconstruction were used three-leaflet prosthetic conduits in 69 patients, xenografts – in 26, homografts –in 11 and autologous techniques - in 45 patients. The mean ischemic time was 116.3 ± 24.9 min (median 112 min), mean CPB time - 187.3 ± 98.4 (median 169 min) and duration of operation was 473.6 ± 136.7 (median 470 min).