Researchers compare three graft types given to kids with aortic root aneurysm

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Here is another older article I hadn't seen before.

http://www.medicalpost.com/mpcontent/article.jsp?content=20030304_150214_140

4

Composite grafts best option

Researchers compare three graft types given to kids with aortic root

aneurysm

By Hodges

SAN DIEGO ­ Research presented here shows composite grafts appear to be the

most effective method for treating aortic root aneurysm, a rare childhood

condition usually associated with connective tissue disorders.

The finding comes from a 21-year retrospective clinical review of hospital

records by researchers at Hopkins Medical Institution in Baltimore.

Recent clinical and echocardiographic followup data on composite grafts,

homografts and valve-sparing procedures were obtained.

" Composite grafts provide excellent long-term results in children with

aortic root aneurysm, and carry a low risk of endocarditis, thromboembolic

or hemorrhagic complications, " said lead study author Dr. Cattaneo,

an assistant resident at s Hopkins.

Between September 1980 and January 2002, 50 children (mean age 13 years,

range one to 18 years) with connective tissue disorders (48 Marfan, two

Ehlers-Danlos) underwent aortic root replacement. There were no hospital

deaths. Of these children, 26 had received a composite graft with a

mechanical prosthesis, 14 had a valve-sparing procedure ( II

remodelling technique) and 10 had homograft aortic root replacement.

Followup showed three late deaths in the composite graft group, three in the

homograft aortic root replacement group and none in the valve-sparing

procedure group. Overall survival was 98%, 92%, 92%, 87% at one, five, 10

and 15 years, respectively.

On late followup (mean 8.2 years) there were no serious thromboembolic or

hemorrhagic events or episodes of prosthetic endocarditis in the composite

graft with a mechanical prosthesis group.

" Homografts are attractive for use in small roots, but their durability has

been disappointing, " Dr. Cattaneo said.

" Valve-sparing procedures, while promising better quality of life, must be

further refined to meet the high standards set by composite grafts.

Indications and optimal timing of surgery are still not well defined. "

Four of the 10 homograft aortic root replacement patients required " redo "

root replacement at a mean of 6.4 years postoperatively. Three valve-sparing

procedure patients required late aortic valve replacement.