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[Prosthetic valve replacement in children]
N Sasahashi1, F Ando, F Okamoto
1Department of Cardiovascular Surgery, Hyogo Kenritsu Amagasaki Hospital, Japan.
Insights
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.
- 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.
Abstract:
Between 1975 and 1998, 27 patients aged 3 months to 14 years underwent replacement of the aortic, mitral, tricuspid, and pulmonary valves. Five different types of prosthetic valves were used; three were mechanical valves and two were bioprosthetic valves. There were 3 hospital deaths. Among the 24 survivors there were 4 late deaths. Arrhythmia requiring pacemaker implantation occurred in 2 cases after AVR and TVR. Thromboembolic events occurred in 3 patients, all with mechanical valves in pulmonary position. Infective endocarditis occurred in 1 patient after PVR with a mechanical valve. No bleeding complication occurred among the patients on a regimen of Coumadin and Dipyridamole. Two patients, both with Hancock bioprosthesis, required a second valve replacement on account of severely calcified changes. Mechanical valves in left side heart had a satisfactory long-term performance. One patient who had undergone MVR for congenital parachute mitral valve received reoperation for growth. A larger sized prosthetic valve should be used at the first replacement, and special procedures including supra-annular positioning or annular augmentation are recommended for MVR or AVR respectively.