Prosthetic valve replacement in infants and children

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Biomedical Engineering

Background:

• Valve replacement in children presents unique challenges compared to adults.
• Rheumatic and congenital heart defects are primary indications for pediatric valve replacement.
• Historical data on long-term outcomes of pediatric valve replacement is crucial for surgical planning.

Purpose of the Study:

• To review outcomes of valve replacement surgery in pediatric patients.
• To analyze the types of valve deformities and surgical procedures performed.
• To assess hospital mortality, late mortality, and complication rates in children undergoing valve replacement.

Main Methods:

• Retrospective review of 41 pediatric patients (10 months to 16 years) who underwent valve replacement between 1966 and 1981.
• Analysis of valve pathology (rheumatic vs. congenital), type of valve replaced (mitral, aortic, or both), and follow-up data.
• Documentation of hospital mortality, late deaths, reoperations, and thromboembolic events.

Main Results:

• A total of 41 children underwent valve replacement; 61% had rheumatic and 39% congenital deformities.
• Mitral valve replacement was performed in 22 children, aortic in 14, and both in 5.
• Hospital mortality was 9.7%, with only one late death over a mean follow-up of 6.75 years. Three children required a second mitral valve replacement, and 4 experienced thromboembolic episodes.

Conclusions:

• Pediatric valve replacement surgery demonstrated acceptable short-term and long-term outcomes during the study period.
• Rheumatic heart disease was the predominant indication for valve replacement in this pediatric cohort.
• Thromboembolic complications and the need for reoperation highlight ongoing challenges in pediatric cardiac valve surgery.