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Valve replacement in children under 15 years with rheumatic heart disease
1Department of Cardiovascular Diseases, La Rabta Hospital, Tunis, Tunisia.
Insights
Pediatric rheumatic heart disease (RHD) surgery showed Starr-Edwards valves had 6.5% mortality, while xenografts had no early deaths but later calcification. Prosthetic valves offered a 70% 10-year survival rate in children.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Biomaterials Science
Background:
- Rheumatic heart disease (RHD) significantly impacts pediatric cardiac health.
- Surgical valve replacement is a critical intervention for advanced RHD in children.
- Long-term outcomes of different valve types in pediatric RHD patients require evaluation.
Purpose of the Study:
- To evaluate the outcomes of single- or double-valve replacement in children with RHD.
- To compare the efficacy and complications of Starr-Edwards caged-ball prostheses versus porcine xenograft valves.
- To assess long-term survival and adverse events in pediatric patients undergoing valve replacement for RHD.
Main Methods:
- Retrospective analysis of 184 children (4-15 years) undergoing valve replacement between 1967-1984.
- Comparison of outcomes between Starr-Edwards caged-ball prostheses and glutaraldehyde-treated porcine xenograft valves.
- Data collection on hospital mortality, valve failure, thromboembolism, anticoagulant use, and long-term survival.
Main Results:
- 12 hospital deaths (6.5%) occurred with Starr-Edwards valves; no deaths with xenografts.
- Xenografts showed high rates of later valve calcification (14/19) and reoperation (11/19).
- Prosthetic valves had 24 thromboembolic episodes; xenografts had only one. 10-year survival was 70% for prosthetic valves.
Conclusions:
- While Starr-Edwards valves had higher initial mortality, xenografts presented significant long-term calcification and reoperation risks.
- Thromboembolism was a notable complication with prosthetic valves, exacerbated by poor anticoagulant compliance.
- Valve selection in pediatric RHD requires balancing early risks against long-term durability and complication rates.
Abstract:
From 1967 through 1984, single- or double-valve replacement for rheumatic heart disease (RHD) was undertaken in 184 children (aged 4 to 15 years) in Tunis. At the time of operation most patients were in an advanced state of cardiac disability, but most of them were still in sinus rhythm. A total of 222 valves were inserted. The most commonly used replacement valve was the Starr-Edwards caged-ball prosthesis, with 12 hospital deaths (6.5%). There were no hospital deaths among 19 children who had a (glutaraldehyde-treated porcine) xenograft replacement valve; however, a much higher rate of valve failure occurred later, owing to valve calcification (14 of 19 replacements, 11 requiring reoperation). There were 24 episodes of clinical thrombo-embolism in 21 children after insertion of a prosthetic valve, but only one in a child with a xenograft valve. Two thirds of the patients with prosthetic valves were on anticoagulants, but fewer than half of them had effective levels because of low compliance. For the group with prosthetic valves, the 10-year survival rate was 70%.