Current status of valve replacement in children

Area of Science:

• Pediatric Cardiac Surgery
• Cardiovascular Research
• Biomaterials Science

Background:

• Management of pediatric valve disease requires tailored surgical strategies.
• Porcine heterografts exhibit accelerated calcification and degeneration in pediatric patients, particularly in aortic and mitral positions.
• This necessitates careful consideration of prosthetic valve selection for children.

Purpose of the Study:

• To evaluate the long-term outcomes of different prosthetic valves in pediatric patients.
• To compare the durability and thromboembolic rates of mechanical valves versus heterografts in children.
• To establish guidelines for prosthetic valve choice in pediatric cardiovascular surgery.

Main Methods:

• Retrospective analysis of pediatric patients undergoing valve repair or replacement.
• Long-term follow-up of patients with Starr-Edwards and Bjork-Shiley mechanical valves.
• Assessment of porcine heterograft performance in specific anatomical positions (atrioventricular, right ventricle-pulmonary artery).

Main Results:

• Porcine heterografts are reserved for specific right-sided positions due to degeneration concerns.
• Starr-Edwards prostheses demonstrate excellent durability and acceptable thromboembolic rates in children.
• Bjork-Shiley valves also show favorable intermediate-term results in pediatric populations.
• Mechanical valves allow children to reach adolescence for potential re-replacement with adult-sized prostheses.

Conclusions:

• Mechanical prosthetic valves are a durable option for pediatric valve replacement, offering good long-term outcomes.
• Porcine heterografts should be used judiciously in pediatric patients due to risks of accelerated degeneration.
• Systemic anticoagulation with warfarin is recommended for all children with mechanical prosthetic valves.