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[Mitral valve replacement with bioprosthesis in children]
Insights
Bioprosthetic mitral valve replacement in children shows higher late mortality in younger patients. Mechanical prostheses are preferred for those under 13, while bioprostheses are suitable for older children, depending on follow-up care.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Context:
- Mitral valve replacement in pediatric patients presents unique challenges.
- Bioprosthetic valves were utilized in 47 pediatric cases between 1975 and 1980.
- Long-term outcomes require careful consideration of patient age and follow-up conditions.
Purpose:
- To evaluate the medium and long-term outcomes of mitral valve replacement using bioprostheses in pediatric patients.
- To compare the efficacy and longevity of bioprosthetic valves versus mechanical prostheses in different pediatric age groups.
- To inform therapeutic strategies for mitral valve replacement in children based on age and follow-up availability.
Summary:
- Late mortality was significantly higher in pediatric patients under 13 years old (11.1%/patient/year) compared to older children (3%/patient/year).
- The incidence of reoperation due to bioprosthetic deterioration was 5.5% per patient/year, with 5-year actuarial longevity of uncomplicated bioprostheses at 48% ± 16%.
- Recommendations favor mitral valvuloplasty when feasible; for valve replacement, mechanical prostheses are preferred in younger children (<13 years) with good follow-up, while bioprostheses are recommended for post-pubertal patients and in cases with limited follow-up due to lower thromboembolism risk.
Impact:
- This study influences current surgical decision-making for pediatric mitral valve replacement.
- It highlights the importance of age-specific strategies and follow-up care in managing pediatric heart valve disease.
- Findings contribute to optimizing long-term patient outcomes and prosthesis selection in pediatric cardiovascular surgery.
Abstract:
Forty seven bioprostheses were used for mitral valve replacement between January 1975 and June 1980, with no operative mortality, in children under 19 years of age. This study was undertaken to evaluate the medium and longterm outcome of 43 patients followed up for at least 2 years. The late mortality was higher in children under 13 years of age (11.1% per patient/year) than in older children (3% per patient/year). The incidence of reoperation for deterioration of the bioprosthesis was 5,5% per patient/year. The actuarial longevity of bioprostheses without any complications was 48 +/- 16% at 5 years. After a review of the literature, the authors discuss their present therapeutic attitude: whenever possible, mitral valvuloplasty is the operation of choice, but when valve replacement is necessary, two criteria must be considered: the age of the patient and conditions of follow up. If medical follow-up facilities are good: mechanical prostheses are preferred in patients under 13 years of age: after puberty especially in girls, the bioprosthesis is the valve of choice. If medical follow-up facilities are poor: the valve of choice is a bioprosthesis at all ages because of the risk of thromboembolism and the relatively slow clinical aggravation in cases of bioprosthetic deterioration.