Related Experiment Videos
[Surgical management of valve replacement in children]
H Kanazawa1, H Miyamura, H Watanabe
1Second Department of Surgery, Niigata University School of Medicine.
Insights
Pediatric heart valve replacements between 1965-1990 show evolving outcomes. Early Starr-Edwards valves had high mortality, while bioprosthetic valves failed quickly, leading to St. Jude Medical (SJM) valve use.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Context:
- Review of pediatric heart valve replacement surgeries performed between 1965 and 1990.
- Analysis of 49 valve replacements in 43 patients under 15 years old.
- Focus on mitral, aortic, tricuspid, pulmonary, and atrioventricular valve procedures.
Purpose:
- To evaluate the efficacy and outcomes of different prosthetic valve types in pediatric patients over a 25-year period.
- To identify trends in valve choice and associated complications.
- To compare the performance of Starr-Edwards (S-E), bioprosthetic, and St. Jude Medical (SJM) valves.
Summary:
- Early mitral valve replacements using S-E ball valves (pre-1974) had a 56% early mortality rate.
- Bioprosthetic valves used since 1975 showed high rates of primary tissue failure within 3 years.
- SJM valves became the preferred choice, though complications like thrombosis were noted in adult cases on the right side of the heart.
Impact:
- Highlights the challenges and evolving strategies in pediatric heart valve surgery.
- Demonstrates the limitations of early prosthetic valve technologies in pediatric populations.
- Provides historical data informing current practices in pediatric cardiac valve replacement.
Abstract:
From 1965 to 1990, 49 valve replacements were performed on 43 patients under the age of 15. Mitral valve replacements were performed on 21 patients, and re-replacements were done on 4 of them afterwards. In the first 9 mitral valve replacements before 1974, Starr-Edwards (S-E) ball valves were used. Five of these patients died in the hospital (early mortality rate was 56%). Since 1975, bioprosthetic valves were used in three cases, but all of these valves ceased to function due to primary tissue failure (PTF) within 3 years. Consequently, SJM valves are now used as a first choice. Ten aortic valve replacements were performed on 9 patients with the results of one early death, two late deaths, and one late re-operation. Tricuspid valve replacements were performed on 11 patients, 5 of whom utilized S-E ball valves. Three of the five patients died in the hospital. One patient was re-operated on, swapping the S-E ball valve for the SJM valve. SJM valves were used primarily in 2 patients, and bioprosthetic valves in 4. Two patients died, one with a SJM valve, and the other with a bioprosthetic valve. Two pulmonary valve replacements were performed, one employing a SJM valve, the other a bioprosthetic valve. Two adult patients with SJM valve in the right side of the heart had thrombotic complications, though the patients with bioprosthetic valves had none. Atrioventricular valve replacements were performed on 5 patients under the age of 3, but all of them died.(ABSTRACT TRUNCATED AT 250 WORDS)