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Tricuspid valve replacement in children
Insights
Pediatric tricuspid valve replacement using prosthetic valves shows a 5-year survival of 68%. While durable, tissue prostheses can calcify, necessitating repair when possible, especially in infants.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Research
- Prosthetic Valve Development
Background:
- Tricuspid valve disease in children presents complex challenges.
- Prosthetic valve replacement is a critical intervention for severe tricuspid valve pathology.
- Understanding long-term outcomes in pediatric patients is essential.
Purpose of the Study:
- To evaluate the outcomes of tricuspid valve replacement in pediatric patients.
- To assess the survival rates and long-term durability of prosthetic tricuspid valves in children.
- To compare outcomes based on patient age and underlying valve morphology.
Main Methods:
- Retrospective review of 11 pediatric patients undergoing 13 tricuspid valve replacements between 1974 and 1986.
- Analysis of patient demographics, valve morphology, operative details, early and late mortality, and reoperation rates.
- Comparison with literature data for estimated 5-year survival rates.
Main Results:
- Four early deaths occurred, primarily in neonates and infants.
- Two late deaths and two reoperations for calcified tissue prostheses were observed at 6.5 and 9 years post-implantation.
- Estimated 5-year survival from literature review is 68% +/- 9% for pediatric patients with prosthetic tricuspid valves.
Conclusions:
- Tricuspid valve repair should be prioritized, particularly in infants.
- Prosthetic valve replacement in older children offers reasonable operative risk and late results.
- While more durable in the tricuspid position, tissue prostheses are susceptible to late calcification and dysfunction.
Abstract:
Between 1974 and January, 1986, 11 children underwent 13 tricuspid valve replacements at the Hospital for Sick Children in Toronto. Age at operation ranged from 24 hours to 14.5 years (mean, 6.9 years). Morphology of the tricuspid valves included Ebstein's anomaly (6 patients), congenital tricuspid regurgitation (3), tricuspid regurgitation and univentricular heart (1), and previous tricuspid valve excision for acute endocarditis (1). There were 4 early deaths: the 3 youngest infants in the series (age 1 day to 16 days) and another child who underwent emergency valve replacement died. On follow-up to 13 years after valve replacement, there were 2 late deaths and two reoperations. Both reoperations were for calcified degenerative tissue prostheses 6.5 and 9 years following implantation. The estimated 5-year survival based on a collected review of data from the literature is 68 +/- 9% for children with prosthetic tricuspid valves. Although tissue valve durability is better in the tricuspid position than on the systemic side of the circulation, calcification does result in late dysfunction. Tricuspid valve repair should always be carried out when possible, especially in the infant group. Elective prosthetic valve replacement in older children can be performed with reasonable operative risk and reasonable late results.