Triple valve repair in children with rheumatic heart disease: long-term experience

Triple valve replacement has poor early and long-term results, particularly in children, and few data are available on triple valve repair. Herein are reported the single-center, long-term results of combined aortic, mitral, and tricuspid valve repair in rheumatic children.

Ten children (mean age 12 +/- 3 years) with severe rheumatic aortic, mitral, and tricuspid regurgitation underwent triple valve repair over a 17-year period, using a tailored cusp extension to repair the aortic valve, and ring annuloplasty and Carpentier's techniques to repair the mitral and tricuspid valves.

There were no early deaths. During a median follow up of 58 months (range: 3 months to 16 years), no late death occurred and four patients (40%) required reoperation at a median of three years (range: 2.7 to 12 years). Reoperations included one for mitral valve replacement, one for aortic valve replacement, and two for aortic and mitral valve replacements. Freedom from reoperation was 100% at one year, 63 +/- 17% at three, five, and 10 years, and 47 +/- 19% at 15 years.

In this particularly challenging patient group, triple valve repair provided satisfactory initial and mid-term results, with a high burden of reoperation in the long term, allowing a median of three years of growth and subsequent placement of a larger valve at the time of actual valve replacement. This strategy might be considered a good palliative surgical approach.