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Simultaneous aortic and mitral valve replacement in children: time-related outcomes and risk factors

Bahaaldin Alsoufi1, Zohair Al-Halees, Bahaa Fadel

  • 1King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. balsoufi@hotmail.com

The Journal of Heart Valve Disease
|June 30, 2010
PubMed

Insights

Combined aortic and mitral valve replacement in children presents high reoperation risks, particularly with mechanical valves. Bioprosthetic valves may be suitable for select patients, including females, to mitigate reoperation needs.

Area of Science:

  • Pediatric Cardiology
  • Cardiac Surgery
  • Valvular Heart Disease

Background:

  • Pediatric valve replacement is challenging, with frequent anticoagulation complications and reoperations.
  • Multiple valve replacements in children can worsen outcomes.
  • This study evaluates combined aortic and mitral valve replacement in pediatric patients.

Purpose of the Study:

  • To assess the short-term and long-term outcomes of simultaneous aortic valve replacement (AVR) and mitral valve replacement (MVR) in children.
  • To identify factors influencing outcomes in pediatric patients undergoing combined AVR and MVR.

Main Methods:

  • Retrospective review of medical records for children undergoing simultaneous AVR and MVR between 1984 and 2004.
  • Analysis of survival, reoperation rates, and complication-free intervals.
  • Mean follow-up duration of 9.7 years.

Main Results:

  • 84 pediatric patients (mean age 15.0 years) underwent combined AVR/MVR, primarily for rheumatic heart disease (94%).
  • 15-year survival was 78% (bioprosthetic 92% vs. mechanical 76%).
  • 15-year freedom from reoperation was 59% overall; bioprosthetic valve use and female gender were risk factors for reoperation.

Conclusions:

  • Simultaneous AVR and MVR in children, though having acceptable operative mortality, leads to significant long-term attrition and high reoperation rates.
  • Bioprosthetic valves may be considered for specific pediatric patient groups, such as females or those with poor anticoagulation compliance.
  • Careful patient selection is crucial for optimizing outcomes in pediatric combined valve replacement surgeries.
Abstract

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