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Immediate and long term evolution of valve replacement in children less than 12 years old
F A Atik1, A R Dias, P M Pomerantzeff
1Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Insights
Mechanical prostheses (MP) are superior to biological prostheses (BP) for pediatric valve replacement, showing fewer re-operations and lower mortality rates. This study highlights MP as the optimal choice for children needing heart valve surgery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Pediatric heart valve replacement is a complex procedure with varying outcomes based on prosthesis type.
- Rheumatic heart disease is a significant indication for valve replacement in children.
- The choice between biological prostheses (BP) and mechanical prostheses (MP) impacts long-term patient health.
Purpose of the Study:
- To evaluate the outcomes of valve replacement in children under 12 years of age.
- To compare the performance of biological prostheses (BP) versus mechanical prostheses (MP) in pediatric patients.
- To assess re-operation rates, infectious complications, and mortality associated with different prosthesis types.
Main Methods:
- A retrospective study of 44 children under 12 who underwent valve replacement between 1986 and 1992.
- Analysis of patient demographics, including etiology (rheumatic), functional class, and emergency status.
- Comparison of outcomes between patients receiving biological prostheses (BP) and mechanical prostheses (MP), including re-operations, endocarditis, thrombosis, hemorrhage, and mortality.
Main Results:
- Hospital mortality was 4.5%. Mechanical prostheses (MP) showed significantly lower re-operation rates (12.5% vs. 63.3% for BP) and no infectious endocarditis compared to BP (26.3%).
- MP group experienced thrombosis in 12.5% and hemorrhage in 6.5%. Delayed mortality was not significantly different between groups (11.9% overall).
- Ten-year actuarial survival was 82.5±7.7%, and re-operation-free survival was 20.6±15.9%.
Conclusions:
- Mechanical prostheses (MP) are associated with superior outcomes in pediatric valve replacement compared to biological prostheses (BP).
- MP demonstrated reduced re-operation rates and a lower incidence of infectious endocarditis.
- The findings suggest mechanical prostheses are the preferred choice for pediatric heart valve replacement due to better long-term results.
Objective:
The aim of this work was the follow-up and evaluation of valve replacement in children under 12 years of age.
Methods:
Forty-four children less than 12 years old were underwent valve replacement at INCOR-HCFMUSP between January 1986 and December 1992. Forty (91%) were rheumatic, 39 (88.7%) were in functional classes II or IV, 19 (43.2%) were operated upon on an emergency basis, and 6 (13.6%) had atrial fibrillation. Biological prostheses (BP) were employed in 26 patients (59.1%), and mechanical prostheses (MP) in 18 (40.9%). Mitral valves were replaced in 30 (68.7%), aortic valves in 8 (18.2%), a tricuspid valve in 1 (2.3%), and double (aortic and mitral) valves in 5 (11.4) of the patients.
Results:
Hospital mortality was of 4.5% (2 cases). The mean follow-up period was 5.8 years. Re-operations occurred in 63.3% of the patients with BP and in 12.5% of those with MP (p=0.002). Infectious endocarditis was present in 26.3% of the BP, but in none of the cases of MP (p=0.049). Thrombosis occurred in 2 (12.5%) and hemorrhage in one (6.5%) of the patients with a MP. Delayed mortality occurred in 5 (11.9%) of the patients over a mean period of 2.6 years; four had had BP and one had a MP (NS). Actuarial survival and re-operation-free curves after 10 years were respectively, 82.5+/-7.7 (SD)% and 20.6+/-15.9%.
Conclusion:
Patients with MP required fewer re-operation, had less infectious endocarditis and lower late mortality rates compared with patients with bioprostheses. The former, therefore, appear to be the best valve replacement for pediatric patients.