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Mechanical valve replacement in congenital heart disease in children
B Lubiszewska1, J Rozanski, M Szufladowicz
1Dept. of General Cardiology, National Institute of Cardiology, Warsaw, Poland.
Insights
Mechanical heart valve replacement in children with congenital heart disease shows good long-term outcomes. Larger mechanical valves (>23mm atrioventricular, >21mm aortic) ensure excellent performance, but tricuspid valves risk thrombosis.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomaterials in Medicine
Background:
- Congenital heart disease necessitates complex surgical interventions.
- Mechanical heart valve replacement is a critical procedure for pediatric patients.
- Long-term outcomes and predictive factors require ongoing investigation.
Purpose of the Study:
- To analyze predictive factors for long-term results after mechanical heart valve replacement in children.
- To evaluate the efficacy and safety of mechanical heart valves in pediatric congenital heart disease.
Main Methods:
- Retrospective analysis of 44 pediatric patients undergoing mechanical heart valve replacement.
- Inclusion of various valve positions: left atrioventricular (mitral, tricuspid), aortic, and tricuspid.
- Data collection on patient demographics, surgical procedures, prosthesis size, and follow-up duration (mean 6.8 years).
Main Results:
- No early mortality; 7% late mortality, primarily in left atrioventricular valve replacement patients.
- Reoperations occurred for patient-prosthesis mismatch, periprosthetic leak, and aortic dissection.
- Thrombotic obstruction was observed, particularly in the tricuspid position, with one fatal event in the left atrioventricular position.
Conclusions:
- Mechanical heart valve replacement in children over one year with congenital heart disease yields satisfactory results.
- Optimal prosthesis sizing is crucial: >23mm for atrioventricular and >21mm for aortic positions.
- Mechanical valves in the tricuspid position present a higher risk of thrombotic occlusion.
Background And Aim Of The Study:
The study aim was to analyze predictive factors of long-term results after mechanical heart valve replacement in children.
Methods:
Forty-four patients (19 males, 25 females; mean age 8.9+/-3.9 years, median 7.0 years, range: 1.3 to 15 years) underwent heart valve replacement with mechanical prostheses. Of these patients, 25 had left atrioventricular valve replacement (LavVR) (18 mitral, six tricuspid in corrected transposition of the great arteries (TGA), one common in a univentricular heart), 13 had aortic valve replacement (AVR) and six had tricuspid valve replacement (TVR). The etiology of the valvular disease was congenital in all patients, and complicated by infective endocarditis in seven (16%). Fifteen patients had undergone previous procedures and 16 required simultaneous repair of associated lesions. The mean size of the implanted prosthesis was 26 mm (range: 19-29 mm) for LavVR, 29.7 mm (range: 23-33 mm) for TVR, and 21.9 mm (range: 19-25 mm) for AVR. Postoperatively, all patients received oral anticoagulation. The mean follow up was 6.8+/-3.5 years (total 290 patient-years).
Results:
There was no early mortality, but three patients (7%) died later; all late deaths occurred in patients with LavVR. There were two sudden deaths, both in patients with complex congenital heart disease and heart failure (before the ACE inhibitor era), and one valve-related death from thrombotic occlusion of a mitral prosthesis. Five patients were reoperated on; three for patient-prosthesis mismatch, one for periprosthetic leak, and one for aortic dissection due to Marfan's syndrome. Thrombotic obstruction occurred in three patients; two in the tricuspid position were treated successfully with thrombolysis, but one in the left atrioventricular position proved fatal. After seven years, the survival rate was 93.4%.
Conclusions:
Mechanical heart valve replacement in children aged over one year with congenital heart disease can be performed with satisfactory early and late results. Mechanical valves of >23 mm diameter in the atrioventricular position in the systemic ventricle, and >21 mm in the aortic orifice, can offer excellent long-lasting hemodynamic performance. However, mechanical valves in the tricuspid position are prone to develop thrombotic occlusion.