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Experience with St. Jude Medical valve prosthesis in children. A word of caution regarding right-sided placement
Insights
The St. Jude Medical valve shows excellent function in children
Area of Science:
- Pediatric Cardiology
- Biomaterials Science
- Surgical Innovation
Background:
- The St. Jude Medical valve is a mechanical prosthesis used in cardiac surgery.
- Pediatric cardiac patients require durable and functional valve replacements.
- Assessing long-term outcomes of mechanical valves in pediatric populations is crucial.
Purpose of the Study:
- To evaluate the performance and complications of St. Jude Medical cardiac prostheses in pediatric patients.
- To compare the outcomes of valves placed in the systemic (left) versus pulmonary (right) sides of the circulation.
- To determine the safety and efficacy of these valves for long-term use in children.
Main Methods:
- Retrospective analysis of 37 St. Jude Medical cardiac prostheses implanted in 36 children (aged 6 months to 18 years).
- Patients received salicylates and dipyridamole post-operatively.
- Follow-up data collected for 12 to 24 months, assessing valve function, thromboembolic events, and functional class.
Main Results:
- No valve dysfunction or thromboembolic complications occurred in 20 patients with valves in the aortic or mitral position (left side).
- Six of 16 patients (37%) with valves in the pulmonary or tricuspid position (right side) experienced prosthesis dysfunction due to fibrous tissue infiltration.
- Actuarial functional life at 2 years was 100% for left-sided valves and 70% for right-sided valves.
Conclusions:
- St. Jude Medical valves demonstrate excellent hemodynamic function and safety in the left side of the pediatric circulation without warfarin.
- High rates of dysfunction in the right side of the circulation limit the suitability of these valves for pulmonary or tricuspid positions in children.
- Further research into alternative valve options for right-sided pediatric cardiac repairs is warranted.
Abstract:
Thirty-six children aged 6 months to 18 years, underwent insertion of 37 St. Jude Medical cardiac prostheses. In 20, the valve was placed in the aortic or mitral position, and in 16 in the pulmonary or tricuspid position. There was one (2.8%) hospital death. All patients received maintenance doses of salicylates and dipyridamole after the operation. Follow-up data are available for all patients for 12 to 24 postoperative months. There was no incidence of valve dysfunction or thromboembolic complication in any of the 20 patients with valves in the systemic (left) side of the circulation, and all manifested improvement in their functional class. In contrast, six (37%) of the 16 patients with valves in the pulmonary (right) side of the circulation developed dysfunction of the prosthesis 1 to 6 months after insertion. Prosthesis failure was associated with fibrous tissue growing into the struts, leading to leaflet immobilization. At 2 years, the actuarial functional life was 100% for mitral and aortic valves and 70% for pulmonary and tricuspid valves. The data illustrate the excellent hemodynamic function of the St. Jude Medical valve in children. The absence of thromboembolic complications warrant continued implantation of the prosthesis in the left side without warfarin anticoagulation therapy, but the high incidence of valve dysfunction in the pulmonary position does not justify its continued use in the right side.