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[Prosthetic valve replacement in children].

N Sasahashi1, F Ando, F Okamoto

  • 1Department of Cardiovascular Surgery, Hyogo Kenritsu Amagasaki Hospital, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|May 5, 1999
PubMed
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Pediatric valve replacement using mechanical or bioprosthetic valves showed good long-term outcomes, with mechanical valves performing well on the left side of the heart. Careful valve selection and sizing are crucial for optimal results in children.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Biomedical Engineering

Background:

  • Pediatric valve replacement is complex due to patient growth and varying valve types.
  • Long-term outcomes of different prosthetic valves in children are not fully established.

Purpose of the Study:

  • To evaluate the long-term performance and complications of various prosthetic valves in pediatric patients undergoing multiple valve replacements.
  • To identify factors influencing outcomes and provide recommendations for future pediatric valve surgeries.

Main Methods:

  • Retrospective analysis of 27 pediatric patients (3 months to 14 years) who underwent aortic, mitral, tricuspid, and pulmonary valve replacements between 1975 and 1998.
  • Utilized five prosthetic valve types: three mechanical and two bioprosthetic.

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  • Monitored for hospital deaths, late deaths, arrhythmias, thromboembolic events, endocarditis, bleeding, and reoperations.

    • Main Results:

    • Hospital mortality was 11.1% (3/27), with late mortality at 16.7% (4/24 survivors).
    • Complications included arrhythmia (2 cases), thromboembolism (3 cases, all with mechanical pulmonary valves), and endocarditis (1 case).
    • Bioprosthetic valves (Hancock) showed calcification requiring reoperation in 2 patients; mechanical left-sided valves demonstrated satisfactory long-term performance.

    Conclusions:

    • Pediatric valve replacement can achieve satisfactory long-term results, particularly with mechanical valves in the left heart.
    • Consideration of patient growth necessitates using larger prosthetic valves and advanced techniques like supra-annular positioning for mitral/aortic valve replacement.
    • Careful prosthetic valve selection and surgical techniques are vital for minimizing complications and ensuring favorable outcomes in pediatric cardiac surgery.