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Prosthetic valves in children and adolescents
L Solymar1, P S Rao, M K Mardini
1Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
American Heart Journal
|February 1, 1991
Summary
Prosthetic valve replacement in children shows significant risks. Mechanical valves are preferred for mitral replacements in younger children, while heterografts may be suitable for older children. Anticoagulant therapy varies by valve type.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Prosthetic valve replacement is a critical intervention for children with severe valve disease.
- Understanding the long-term outcomes and complications is essential for optimizing pediatric cardiac care.
Purpose of the Study:
- To evaluate the short- and long-term results of prosthetic valve replacement in pediatric patients.
- To compare outcomes based on valve type (mechanical vs. heterograft) and position (aortic, mitral, multiple).
Main Methods:
- Retrospective analysis of 186 pediatric patients (ages 1-20) undergoing valve replacement between 1978 and 1985.
- Categorization of valve types, lesion origins (rheumatic, congenital, infectious), and surgical procedures.
- Assessment of surgical mortality, actuarial survival, and complication-free survival rates.
Main Results:
- Overall surgical mortality was 3.6% (aortic), 4.2% (mitral), and 19.4% (multiple valve replacement).
- Five-year actuarial survival rates were 91% (aortic), 82% (mitral), and 60% (multiple).
- Heterografts are not recommended for mitral valve replacement in children 15 years or younger due to poorer outcomes.
Conclusions:
- Prosthetic valve replacement in children is associated with significant morbidity and mortality.
- Preservation of native valves through repair should be prioritized whenever possible.
- Specific anticoagulant strategies are recommended based on valve position to mitigate thromboembolic risks.
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