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Intermediate-term results in pediatric aortic valve replacement
F M Lupinetti1, B W Duncan, A M Scifres
1Department of Surgery, Children's Hospital and Regional Medical Center and the University of Washington, Seattle 98105, USA. mlupin@chmc.org
Insights
Human tissue valves offer better survival and fewer complications than mechanical valves for pediatric aortic valve replacement (AVR). This suggests human valves are a superior option for children needing AVR, with Marfan syndrome as a potential exception.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Aortic valve replacement (AVR) in pediatric patients increasingly utilizes human tissue valves.
- The choice between mechanical and human valves involves balancing durability and complication risks.
Purpose of the Study:
- To compare the intermediate-term outcomes of mechanical versus human valves in pediatric AVR.
- To evaluate survival rates and freedom from valve-related complications in both groups.
Main Methods:
- Retrospective review of 100 consecutive pediatric AVRs.
- Stratification into two groups: 50 mechanical valves and 50 human valves.
- Analysis of perioperative and late complications, mortality, and reoperations.
Main Results:
- The human valve group showed significantly better 4-year actuarial survival (98% vs. 83%) and freedom from complications (88% vs. 61%) compared to the mechanical valve group (p=0.02 and p=0.008, respectively).
- The mechanical valve group experienced higher rates of late death, endocarditis, and thromboembolic events.
- Reoperations in the human group were primarily for allograft deterioration in Marfan syndrome patients.
Conclusions:
- Human valves demonstrate superior intermediate-term outcomes in pediatric AVR compared to mechanical valves.
- Human valves significantly reduce mortality and valve-related complications in children.
- Marfan syndrome may be a relative contraindication for human valve use in pediatric AVR.
Background:
Aortic valve replacement (AVR) in children is now more commonly performed with human tissue valves.
Methods:
The results of 100 consecutive pediatric AVRs (50 mechanical, 50 human) were reviewed.
Results:
There were five perioperative deaths in the mechanical group and one in the human group (p = 0.2). Late complications in the mechanical group included 4 late deaths, 2 cases of endocarditis, 3 thromboembolic complications, and 10 reoperations on the aortic valve. In the human group, there were no late deaths, 2 reoperations for allograft aortic valve deterioration (both in Marfan's patients), and 1 reoperation for allograft pulmonary valve stenosis. Four-year actuarial survival was 83% in the mechanical group and 98% in the human group (p = 0.02). Four-year actuarial survival free of all valve-related complications was 61% in the mechanical group and 88% in the human group (p = 0.008).
Conclusions:
Human valves in children requiring AVR provide superior intermediate-term survival and freedom from valve-related complications compared to mechanical valves. Marfan's syndrome may represent a rare remaining contraindication for human AVR in children.