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Published on: December 11, 2017
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.
Insights
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.
Abstract:
Ninety-four children ranging from 3 months to 19 years of age underwent cardiac valve replacement at Columbia Presbyterian Medical Center from 1965 to 1985. The overall operative mortality was 12%, but mortality was higher among patients less than 2 years of age, patients who had had previous cardiac operations, and patients requiring double-valve replacement. Seven of 11 patients who received mechanical valves and no anticoagulation experienced major thromboembolic events. An episode of gastrointestinal hemorrhage that was easily controlled represents the only bleeding complication in the entire series. Valve replacement in children continues to be a high-risk procedure, and efforts to preserve native valve function should be attempted when technically feasible. Our data also suggest that anticoagulation can be safely accomplished in the pediatric age group and should be employed in patients requiring placement of a mechanical prosthesis, especially in the mitral position.
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