Tissue valves in young patients--a recipe for disaster

Between 1984 and 1987, tissue valves were used for valve replacement in 37 patients less than 20 years of age. In 26 patients, porcine valves were used and in 11 patients, antibiotic sterilized allografts were used. Follow-up of these patients is from 3 to 6 years. In the xenograft series, 13 patients developed documented calcific stenosis of the valve resulting in death or reoperation, and three patients died in circumstances strongly suggesting prosthetic dysfunction. In the group where homografts were used, four patients have developed valve degeneration. Of the 37 patients in whom tissue valves were used, only 11 are currently well with the original prosthesis. In sharp contrast we have a group of 55 young patients in whom a tilting disc valve (Medtronic Hall) was implanted between 1983 and 1987. During the period of follow-up, there have been three episodes of thrombotic valve obstruction of which one was fatal. There have been three systemic emboli, and actuarial freedom from valve-related death, reoperation, or thromboembolism is predicted at 85% at 7 years. In our experience, allografts and xenografts have been found totally unsatisfactory in young patients. Their use should be abandoned in favor of mechanical valves in this age group.