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Cardiac valve replacement in children: a twenty-year series
R C Robbins1, F O Bowman, J R Malm
1Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY.
The Annals of Thoracic Surgery
|January 1, 1988
Summary
Pediatric cardiac valve replacement is high-risk, especially for young children and those needing multiple valve surgeries. Anticoagulation is recommended for mechanical valve recipients to prevent clots.
Area of Science:
- Cardiology
- Pediatric Surgery
Background:
- Cardiac valve replacement in children is a complex procedure with significant risks.
- Previous studies on pediatric valve replacement outcomes are limited.
Purpose of the Study:
- To evaluate the outcomes of cardiac valve replacement in a pediatric population.
- To identify risk factors associated with operative mortality and complications.
- To assess the safety and efficacy of anticoagulation in pediatric patients with mechanical valves.
Main Methods:
- Retrospective review of 94 pediatric patients (3 months to 19 years) who underwent cardiac valve replacement between 1965 and 1985.
- Analysis of operative mortality, thromboembolic events, and bleeding complications.
- Comparison of outcomes based on age, prior cardiac operations, and type of valve replacement.
Main Results:
- Overall operative mortality was 12%, with higher rates in younger children (<2 years), those with prior operations, and double-valve replacements.
- Seven of 11 patients with mechanical valves and no anticoagulation experienced major thromboembolic events.
- Only one case of easily controlled gastrointestinal hemorrhage was reported.
Conclusions:
- Pediatric cardiac valve replacement remains a high-risk procedure, emphasizing the importance of native valve preservation when feasible.
- Anticoagulation is safe and recommended for pediatric patients with mechanical prostheses, particularly in the mitral position, to mitigate thromboembolic risks.