Çocuk hastalarda aort kökü ve asendan aort anevrizmasında cerrahi tercihler: tek merkez deneyimi

Year 2024, Volume: 49 Issue: 1, 130 - 140, 29.03.2024

Mustafa Yılmaz Başak Soran Türkcan Ata Niyazi Ecevit İbrahim Ece Atakan Atalay

https://doi.org/10.17826/cumj.1396469

Abstract

Amaç: Çocuk hastalarda aort kökü ve asendan aort anevrizmalarına nadiren rastlanmaktadır. Bu çalışmadaki amacımız, bu hasta grubundaki cerrahi yaklaşımımızı ve sonuçlarımızı literatürdeki benzer çalışmaları ile karşılaştırmaktır.
Gereç ve Yöntem: Bu çalışma, dizayn olarak retrospektif gözlemsel bir çalışma olup kohortunu aort kökü ve /veya asendan aort anevrizması nedeniyle opere edilmiş çocuk hastalar oluşturmaktadır. Hastaların preoperatif dönemde anevrizma sebepleri araştırılmış, detaylı görüntüleme yöntemleri kullanılarak aort kapak ve asendan aorttaki hastalığın ciddiyeti ve cerrahi endikasyonları ortaya konmuştur. Sonrasında, sırayla operasyona ait, erken postoperatif morbidite ve mortalite verileri toplanmıştır. Taburculuk sonrası aort kapak fonksiyonları takip edilmiştir. Elde edilen veriler literatürdeki benzer çalışmaların verileri ile kıyaslanmıştır.
Bulgular: Aort kök ve asendan aort anevrizması tanısı ile toplam 8 çocuk hasta opere edildi. Hastaların ortalama yaşı 11 (±4.03) idi. 3 (%37.5) hastanın altta yatan sebebi Marfan sendromu iken ,2 sinin (%25) biküspit aort kapağı, 1 er (%12.5) hastanın ise Wiscott-Aldrich Sendromu, öncesinde opere edilmiş sinüs valsalva anevrizması ve opere edilmiş trunkus arteriosusdu. 6 hastada (%75) 3. derece aort kapak yetmezliği mevcuttu. Hastaların ortalama aort anülüs çapı, sinüs valsalva ortalama çapı ve asendan aorta çapı sırasıyla 26.7mm (±5,3), 40.9 mm (±9,7) ve 37,8mm (±9,2) idi. 3 (%37.5) hastada David I prosedürü uygulanmışken, diğer 5 hastada Bentall prosedürü ya da aort kapak ve asendan aort replasmanı uygulanmıştır. 1 (%12.5) hastada non kardiyak mortalite izlenmiş olup, taburculuk sonrası takiplerde hiçbir hastada nativ veya mekanik kapak disfonksiyonu izlenmemiştir.
Sonuç: Hem kapak koruyucu cerrahi prosedürler, hem de diğer replasman teknikleri aort kök ve asendan aort anevrizmalı çocuk hastalarda güvenle kullanılabilmektedir.

Keywords

Asendan aort anevrizması, pediatrik, aort kapak

Surgical preference for aortic root and ascending aortic aneurysm in pediatric patients: single-center experience

Abstract

Purpose: Aortic root and ascending aortic aneurysms are rarely encountered in pediatric patients. Our aim in this study was to compare our surgical approach and results in this patient group with similar studies in the literature.
Materials and Methods: This study retrospective in design and its cohort consists of pediatric patients who were operated on due to the diagnosis of aortic root and/or ascending aortic aneurysm. The etiologies of the patients that caused the aneurysm were investigated preoperatively, and the severity of the disease in the aortic valve and ascending aorta and surgical indications were revealed with detailed imaging methods. Operative data was then retrieved and early postoperative morbidity and mortality, as well as post-discharge aortic valve functions were evaluated. The obtained data was compared with those of similar articles in the literature.
Results: A total of eight pediatric patients were operated on with the diagnosis of aortic root and ascending aortic aneurysm. The average age of the patients was eleven (±4.03) years. The underlying cause of three (37.5%) patients was Marfan syndrome, two (25%) had bicuspid aortic valve and one (12.5%) had Wiscott-Aldrich Syndrome, previously operated sinus valsalva aneurysm and operated truncus arteriosus. There was 3rd degree aortic valve insufficiency in six patients (75%). The average aortic annulus diameter, mean sinus of valsalva diameter and ascending aorta diameter of the patients were 26.7 mm (±5.3), 40.9 mm (±9.7) and 37.8 mm (±9.2), respectively. The David I procedure was performed in three (37.5%) patients, while the Bentall procedure or aortic valve and ascending aorta replacement was performed on the other five patients. Non-cardiac mortality was observed in one (12.5%) patient, whereas native and mechanical valve dysfunction was not observed in any patient after discharge.
Conclusion: Both valve-sparing surgical procedures and other replacement techniques can be used safely in pediatric patients with aortic root and ascending aortic aneurysms.

Keywords

Ascending aortic aneurysm, Pediatrics, Aortic Valve

References

• Buratto E and Konstantinov IE. Valve-sparing aortic root surgery in children and adults with congenital heart disease. J Thorac Cardiovasc Surg. 2021;162:955-62.
• Fraser III CD, Liu RH, Zhou X, Patel ND,Lui C, Pierre AS et al. Valve-sparing aortic root replacement in children: outcomes from 100 consecutive cases. J Thorac Cardiovasc Surg. 2019;157:1100-9.
• Lange R, Badiu CC, Vogt M, Voss B, Hörer J, Prodan Z et al. Valve-sparing root replacement in children with aortic root aneurysm: mid-term results. Eur J Cardiothorac Surg. 2013;43:958-64.
• Zarate YA, Sellars E, Lepard T, Carlo WF, Tang X and Collins RT .Aortic dilation in pediatric patients. Eur J Pediatr. 2015;174:1585-92.
• David TE and Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992;103:617-22.
• Khachatryan Z, Herajärvi J, Leontyev S and Borger MA. Valve-sparing aortic root replacement can be done safely and effectively in acute type a aortic dissection. J Thorac Cardiovasc Surg. 2022;164:814-19.
• Jain D, Dietz HC, Oswald GL, Maleszewski JJ and Halushka MK. Causes and histopathology of ascending aortic disease in children and young adults. Cardiovasc Pathol. 2011;20:15-25.
• Karthekeyan BR, Vakamudi M and Thangavel P. Repair of idiopathic ascending aortic aneurysm in a 7-year-old child. Cardiol Young. 2015;25:154-57.
• Zanotti G, Vricella L and Cameron D. Thoracic aortic aneurysm syndrome in children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2008:11-21.
• Zafar MA, Li Y, Rizzo JA, Charilaou P, Saeyeldin A, Velasquez CA et al. Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm. J Thorac Cardiovasc Surg. 2018;155:1938-50.
• Mariucci E, Donti A, Guidarini M, Oppido G, Angeli E, Lovato L et al. Diagnostic accuracy of aortic root cross-sectional area/height ratio in children and young adults with marfan and loeys-dietz syndrome. Congenit Heart Dis. 2016;11:276-82.
• Robicsek F, Daugherty HK, Mullen DC, Harbold NB and Masters TN. Is there a place for wall reinforcement in modern aortic surgery? Arch Surg. 1972;105:824-29.
• Sarsam MA and Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg. 1993;105:435-38.
• Freeman KA, Arnaoutakis GJ, Jeng EI, Martin TD and Beaver TM. Florida sleeve operative technique. Oper Tech Thorac Cardiovasc Surg. 2021;26:306-21.
• Treasure T, Takkenberg JJ, Golesworthy T, Rega F, Petrou M, Rosendah U et al. Personalised external aortic root support (PEARS) in marfan syndrome: analysis of 1–9 year outcomes by intention-to-treat in a cohort of the first 30 consecutive patients to receive a novel tissue and valve-conserving procedure, compared with the published results of aortic root replacement. Heart. 2014;100:969-75.
• David TE, David CM, Feindel CM and Manlhiot C. Reimplantation of the aortic valve at 20 years. J Thorac Cardiovasc Surg. 2017;153:232-38.
• Patel ND, Arnaoutakis GJ, George TJ et al. Valve-sparing aortic root replacement in children: intermediate-term results. Interact Cardiovasc Thorac Surg. 2011;12:415-19.
• Aicher D, Langer F, Kissinger A, Lausberg H, Fries R and Schafers HJ. Valve-sparing aortic root replacement in bicuspid aortic valves: a reasonable option? J Thorac Cardiovasc Surg. 2004;128:662-68.
• Cameron DE, Alejo DE, Patel ND, Nwakanma LU, Weiss ES, Vricella LA et al. Aortic root replacement in 372 Marfan patients: evolution of operative repair over 30 years. Ann Thorac Surg. 2009;87:1344-50.
• Gillinov AM, Zehr KJ, Redmond JM, Gott VL, Deitz HC, Reitz BA et al. Cardiac operations in children with marfan’s syndrome: indications and results. Ann Thorac Surg. 1997;64:1140-45.
• Cattaneo SM, Bethea BT, Alejo DE, SpevakPJ, Clauss SB, Deitz HC et al. Surgery for aortic root aneurysm in children: a 21-year experience in 50 patients. Ann Thorac Surg. 2004;77:168-76.
• Roubertie F, Ben AW, Raisky O, Tamisier D, Sidi D and Vouhe PR. Aortic root replacement in children: a word of caution about valve-sparing procedures. Eur J Cardiothorac Surg. 2009;35:136-40.
• Zanotti G, Vricella L and Cameron D. Thoracic aortic aneurysm syndrome in children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2008;11:11-21.