We have performed the AVaTAR procedure in children to test the surgical method in a clinical setting.
Materials and methods: Preoperative evaluation consisted mainly in a clinical and echocardiographic evaluation. The native valve morphology was evaluated to thoroughly describe the anatomy and measure the dimensions at each level of the arterial root. The most important variable is the diameter of the sinotubular junction (STJ). Then, the native valve performance was tested, and the degree of stenosis and/or regurgitation were assessed.
We have used this method in the aortic position in 11 patients. During the operation, the native aortic valve anatomy was evaluated.
With the AVaTAR procedure, the native valve is replaced by a trileaflet symmetric oversized valve.
Media aortic cross-clamping time: 84 min
Median CPB time: 112 min
Concomitant procedures: pulmonary valve replacement (2), LVOT enlargement (1)
Results: Postoperative evaluation demonstrates that the valve is competent and non-stenotic. It also shows that it is symmetric and has an intended oversizing (unique characteristics of AVaTAR). This oversizing is characterized by 3 features, an increased coaptation length, a windmill shape and a billow below the annular plane, that give the neo-valve the ability to accommodate to the child´s growth.
Conclusions: The AVaTAR procedure demonstrates good mid-term results in the treatment of aortic valve diseases, especially in children, becoming an alternative for its reproducibility, versatility, ability to accommodate to patient´s growth, avoidance of anticoagulation and preservation of the native annulus growth.
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