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Prosthetic valve replacement in children
Insights
Prosthetic valve replacement in children shows promising results with low operative mortality and good long-term outcomes, even without routine anticoagulation. This procedure is recommended for children with severe valvular malfunction unresponsive to medical management.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomaterials Science
Background:
- Previous studies indicated high operative mortality for prosthetic valve replacement in pediatric patients.
- Valvular heart disease in children presents unique challenges for surgical intervention.
Purpose of the Study:
- To evaluate the clinical experience and outcomes of prosthetic valve replacement in a pediatric population.
- To assess the feasibility and safety of prosthetic valve implantation in children.
Main Methods:
- Surgical implantation of 25 prosthetic valves in 24 pediatric patients.
- Retrospective analysis of operative mortality, late mortality, and long-term complications.
- Assessment of embolism rates in patients not undergoing elective anticoagulation.
Main Results:
- One operative death occurred in 24 patients (4.1% operative mortality).
- One late death was attributed to pacemaker malfunction; other patients demonstrated excellent long-term outcomes.
- The long-term embolism rate did not exceed that observed in adults on warfarin therapy.
Conclusions:
- Prosthetic valve replacement in children can be performed with acceptable operative mortality and favorable long-term results.
- Myocardial preservation is a key objective, achievable with current prostheses.
- Valve replacement should be considered for pediatric patients with valvular malfunction refractory to medical management.
Abstract:
Reported clinical experience with prosthetic valve replacement in children have suggested a high operative mortality. We placed 25 valves in 24 children with one operative death. There has been one late death related to pacemaker malfunction, but the remainder of the patients have generally done extremely well. The children have not undergone elective anticoagulation, and the long-term embolism rate has not exceeded the incidence of systemic embolization in adults who have been controlled on warfarin sodium (Coumadin) therapy. The objective of prosthetic valve replacement is myocardial preservation. We believe that valve replacement with currently available prostheses should be undertaken in any child with valvular malfunction who is not well controlled with good medical management.