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Early outcomes of tricuspid valve replacement in young children

Heather L Bartlett1, Dianne L Atkins, Trudy L Burns

  • 1Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. heather-bartlett@uiowa.edu

Circulation
|January 4, 2007
PubMed

Insights

Tricuspid valve replacement in children under six has high mortality, particularly for infants under one year. Alternative surgical options like transplantation may be necessary for this vulnerable group.

Area of Science:

  • Pediatric Cardiology
  • Cardiac Surgery
  • Congenital Heart Disease

Background:

  • Outcomes of tricuspid valve replacement in young children are not well-defined.
  • A review of the Pediatric Cardiac Care Consortium's experience (1984-2002) was conducted.
  • The study focused on children younger than 6 years undergoing tricuspid valve replacement.

Purpose of the Study:

  • To evaluate the early outcomes of tricuspid valve replacement in young children.
  • To identify factors associated with mortality and complications.
  • To inform treatment decisions for pediatric patients with tricuspid valve disease.

Main Methods:

  • Analysis of 97 patients who underwent initial tricuspid valve replacement.
  • Evaluation of diagnoses including Ebstein's anomaly, pulmonary atresia, and tetralogy of Fallot.
  • Statistical analysis using chi-squared and logistic regression to assess outcome predictors.

Main Results:

  • Hospital mortality was 26%, significantly higher (64%) in infants under 1 year.
  • A large valve size-to-weight ratio (>2.5) was the strongest predictor of mortality (P<0.001).
  • Complications included heart block requiring pacemaker (13%) and thrombosis (5%); mechanical valves increased pacemaker need.

Conclusions:

  • Tricuspid valve replacement in young children is associated with high mortality, especially in infants.
  • Consideration of alternative surgical strategies, such as heart transplantation, is warranted for infants.
  • Improved patient selection and surgical techniques may be needed to reduce adverse outcomes.
Abstract

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