Pediatric aortic and mitral valve repair versus replacement

Repairing the aortic and mitral valves of children is not as common as replacement with mechanical or tissue valves, but it has distinct advantages.

If we can keep the child’s own tissue and have good function of the valve, we don’t have to deal with the risk of clotting or bleeding that comes with a mechanical valve. Mechanical valves require anticoagulants, while tissue valves degenerate, requiring reoperation within a few years.

Another important advantage is the repaired valve will grow with the child. This is especially valuable in very small children, who will quickly outgrow a replacement valve.

Also, by repairing the valve, we haven’t burned any bridges. If the valve repair fails in the future, there is always the option of valve replacement when the child is bigger, with the possibility of surgical alternatives.

Cardiac valve repair requires a special skill, with a steep learning curve, and there is an element of art in the procedure.

I’ve always been interested in pediatric valve surgery in general and valve repair in particular, and I was lucky to have learned from many excellent surgeons during my training. Part of my training was with a pioneer in the field of valve repair, Tirone David, M.D., at Toronto General Hospital and the University of Toronto in Ontario, Canada. Dr. David has published widely. He’s developed important principles in aortic and mitral valve repair that have been adopted around the world. He even has aortic valve-sparing surgery named after him, the David procedure.

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Until recently, aortic valve repair has lagged behind mitral valve repair because it is more challenging. That has been changing in the last decade with a number of new approaches to the procedure, most notably a recent development stabilizing the aortic valve annulus with a ring during the repair.

Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, is one of the few programs to work with J. Scott Rankin, M.D., the surgeon who developed the ring for aortic valve repair. Dr. Rankin came to Norton Children’s Heart Institute to work with the team on a number of very challenging cases and continues to do so. Using the ring has shown early promise, with more durable results than previous techniques.

Valve repair isn’t always the answer, and some valves are too diseased to be repaired. But whenever we can repair a valve so a child can keep their own, it is preferable. At Norton Children’s Heart Institute, we’re proud we can offer that to our patients and their families.

Bahaaldin Alsoufi, M.D., is medical director of pediatric cardiovascular surgery at Norton Children’s Hospital.