Pediatric Aortic Valve Replacement and Aortic Valve Repair

A valve is a structure in a tube that allows the passage of blood in only one direction. The aortic valve is one of the heart’s four valves and is the exit valve of the main pumping heart chamber. It connects the heart with the vessel that brings blood to the body called the aorta.

A repair is a restoration of the function of the valve by using only the heart’s existing tissue.

When the valve has aortic stenosis, meaning it is too narrow or blocked, the valve is opened to clear the obstruction in the flow of blood out of your child’s heart. If the valve has regurgitation, meaning that the valve leaks, the valve is folded or complicated to make competent again, our goal is to decrease leakage.

During open-heart surgery, the existing damaged valve is replaced with a replacement valve made from either: artificial material, animal tissues, human preserved valves or, in the Ross procedure, another valve from the heart called the pulmonary valve.

Your child’s aortic valve may need to be replaced if:

• The child has aortic valve stenosis. This narrowing of the valve can cause chest pain, shortness of breath, fainting or heart failure in adolescents or adults. Often in babies and children, however, we can see no complaints until a fatal event. It is called critical aortic valve stenosis when it happens in babies because their condition may be so severe that it requires them to be placed in the Cardiac Intensive Care Unit (CICU) for an emergency repair of the valve.
• The child has aortic valve regurgitation. In this case, the valve is leaky and allows blood to flow backward causing the heart to progressively get weaker.

Your child’s cardiologist and cardiac surgeon will figure out if your child needs an aortic valve procedure.

For this procedure, a cut is made in your child’s chest. Under cardiopulmonary bypass, the heart-lung machine, the heart is arrested, the aorta is opened and the valve is inspected. If the valve can be easily repaired and it seems that the valve’s tissue is suitable enough to last for a long time, this option is preferred. If the valve’s tissue is too thick or retracted, then the valve will be replaced. The valve is cut out to make room for a new valve to be placed into position.

There are different options for the material used to replace the valve:

• Mechanical valves can last for a long time but will require your child to take daily blood-thinning drugs. The blood-thinning drugs can promote bruising and require close monitoring via blood samples tested regularly.
• Artificial valves made of animal tissues are an option, however, they do not last very long in children and adolescents, as they need to be replaced after a few years.
• A homograft is a human tissue that is cryopreserved, frozen in very cold temperatures. This valve is a little better than the animal tissue valve and can last longer.
• In the Ross Procedure, the pulmonary valve, the valve between the heart and the lung vessels, which looks the same as the aortic valve is harvested or taken out and put in the position of the aortic valve. It has now been demonstrated that children, adolescents and young adults have a longer life if they have an aortic valve replacement with the Ross procedure rather than a mechanical or animal tissue valve.

During the recovery phase, your child will be cared for in our Cardiac Intensive Care Unit (CICU) for 1-3 days before being transferred to the ward. After the operation, the CICU team will provide the medications, monitor for signs of infection at the incision site, check vital signs and manage your child’s pain. The length of stay will depend on the child’s age and the severity of the condition at the time of admission and surgery. Echocardiography (ECG) will be done to ensure that the child’s heart is fine to go home. From there, the recovery process can continue for another one to two weeks.

Children who have a valve replacement need antibiotic prophylaxis throughout their lifetime, which means taking antibiotics every time there is a minor operation or dental care. Your child's cardiologist will follow the status of the aortic valve and may give you medication for the first few months after the surgery and will guide what medication may be needed for the long term. We recommended that your child have a yearly visit with their cardiologist.

Depending on your child’s health the risk may include:

• Bleeding
• Blood clots
• Heart rhythm problems
• Infection
• Valve dysfunction after the procedure
• Pacemaker