Heart Valve Replacement in Children: Homografts to Partial Heart Transplantation

Congenital valvular abnormalities in pediatric patients represent a complex surgical problem that carries with it significant morbidity and mortality. Repair of native valves may not always be feasible, leading to requisite surgical intervention. This has led to the development of mechanical valves, bioprosthetic valves, homografts, stented valves, the Ross operation, and finally, the ultimate development of partial heart transplantation. Each technique carries with it potential benefits and limitations. A comprehensive literature search in concert with expert opinion was completed. This yielded a total of 35 applicable references, with the goal to describe the indications, benefits, and risks associated with each approach. Pediatric patients present a unique problem when considering intervention for irreparable valvular abnormalities. Each technique provides a unique opportunity for mitigation of extant pathology but carries with it potential for risks that are inherent to the approach and must be considered. Partial heart transplant is the only technique which provides the opportunity for definitive valvular replacement in pediatric patients. Although each technique does provide an opportunity to resolve congenital valvular disease, the development of partial heart transplantation is a revolutionary technique that is unique in its ability to grow with the patient. The remaining techniques, at a minimum, require further intervention as the patient grows and develops. Although the literature is clear that there are a variety of options available to surgeons, there is only 1 which can resolve congenital valvular disease with 1 operation.