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Valve Replacement in Children with Single Ventricle Physiology
Noor Alshami1, Amber Leila Sarvestani1, Amanda S Thomas2
1Department of Pediatrics, University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, 64108, USA.
Pediatric Cardiology
|November 18, 2019
Summary
Valve replacement for severe heart valve regurgitation in single ventricle physiology shows poor outcomes, particularly for atrioventricular valve replacement. Alternative strategies are recommended for these complex pediatric cardiac cases.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Severe atrioventricular valve (AVV) or semilunar valve (SLV) regurgitation in single ventricle physiology often necessitates valve replacement when repair fails.
- Limited outcome data exists for pediatric patients undergoing these interventions.
Purpose of the Study:
- To evaluate transplant-free survival after atrioventricular valve replacement (AVVR) or semilunar valve replacement (SLVR) in children with single ventricle physiology.
- To identify outcomes associated with these valve replacement procedures in a pediatric population.
Main Methods:
- A multi-institutional case series utilizing the Pediatric Cardiac Care Consortium (PCCC) registry.
- Outcomes data linked with the National Death Index (NDI) and Organ Procurement Transplant Network (OPTN).
- Analysis of 50 children with single ventricle physiology who underwent either AVVR (n=38) or SLVR (n=12).
Main Results:
- In-hospital mortality was high: 42% for AVVR and 8% for SLVR.
- Intraoperative deaths occurred exclusively in the AVVR group (8 deaths).
- Post-discharge, 10 of 33 survivors faced death or cardiac transplant, predominantly among AVVR patients.
Conclusions:
- Valve replacement, especially AVVR, in children with single ventricle physiology is associated with significant morbidity and mortality.
- These findings suggest that alternative palliative strategies should be explored for single ventricle patients with severe AVV or SLV regurgitation.
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