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Valve replacement in children less than 5 years of age
Insights
Pediatric valve replacement surgery improved hemodynamics in children under five. While mortality rates decreased significantly, they remain higher than in adults, especially for operative deaths within three days.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Research
- Medical Device Technology
Background:
- Pediatric heart valve replacement is a complex procedure with significant implications for young patients.
- Understanding long-term outcomes and complications is crucial for improving surgical strategies.
Purpose of the Study:
- To analyze the outcomes of valve replacement surgery in children under five years of age.
- To evaluate the trends in mortality, survival rates, and postoperative complications over time.
Main Methods:
- Retrospective analysis of 70 valve replacement surgeries performed between 1966 and 1984 in children under five.
- Review of patient data including indications, valve types, operative outcomes, and long-term follow-up.
Main Results:
- Mortality rates declined significantly, from 76% before 1979 to 22% since 1982.
- One and five-year survival rates for patients operated on since 1980 were 73% and 51%, respectively.
- Postoperative complications included thromboembolism (1.6%) and hemorrhage (0.8%), with complete heart block occurring in 14.1% of patients.
Conclusions:
- Pediatric valve replacement leads to substantial hemodynamic improvement.
- While outcomes have improved, mortality remains a concern, particularly operative deaths.
- Continued advancements in surgical techniques and prosthetic valves are essential for better pediatric cardiac care.
Abstract:
Between 1966 and 1984, there were 63 children less than 5 years of age who underwent 70 valve replacements (49 mitral [5 repeat], 6 aortic, 11 tricuspid [systemic ventricle; 2 repeat]), 2 tricuspid [pulmonary ventricle] and 1 multiple [mitral-aortic]) at Children's Hospital. Tissue valves were used in 20%. Since 1980, only Björk-Shiley and St. Jude valves have been used. The most common indication for valve replacement was mitral regurgitation after repair of atrioventricular (AV) canal (34%). Mortality dropped considerably over time: 76% before 1979, 33% from 1979 to 1982 and 22% since 1982. More than two-thirds of fatalities were operative deaths, usually within 3 days of surgery. Actuarial survival curves for those operated on since 1980 predict 1 and 5 year survival of 73 and 51%, respectively. For the 46 operative survivors 1 and 5 year valve survival was 97 and 70%, respectively. Postoperative hemodynamics were significantly improved on elective postoperative catheterizations. All but one patient with non-tissue valves received anticoagulant therapy. Postoperative complications included thromboembolism (1.6/100 patients-years) and hemorrhage (0.8/100 patient-years). The frequency of intravascular hemolysis and endocarditis was 1.6%, comparable with adult experience. Complete heart block requiring a pacemaker developed in nine patients (14.1%), in all after AV valve replacement. Valve replacement in young children generally results in considerable hemodynamic improvement. The mortality rate remains above that observed in adults but has declined considerably for those operated on after 1980.