[Mitral valve replacement with bioprosthesis in children].

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.