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Early experience with the ionescu-shiley pericardial xenograft valve. Accelerated calcification in children
Insights
The Ionescu-Shiley valve showed no thromboembolism in pediatric patients but had a high rate of calcific stenosis requiring reoperation. Researchers now recommend mechanical valves for children.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Thromboembolism and anticoagulation pose risks in pediatric patients requiring valve replacement.
- Porcine valves exhibit a high incidence of calcification in younger populations.
- The Ionescu-Shiley valve was considered for its potential benefits in children.
Purpose of the Study:
- To evaluate the efficacy and safety of the Ionescu-Shiley valve in pediatric patients.
- To assess the incidence of calcification and reoperation rates in children receiving this valve prosthesis.
Main Methods:
- A retrospective analysis of 2,372 Ionescu-Shiley valve implantations between 1978 and 1982.
- Focus on a subgroup of 30 pediatric patients (16 years or younger).
- Monitoring for thromboembolism, infection, disruption, and calcific stenosis.
Main Results:
- No instances of thromboembolism, valve infection, or valve disruption were reported in the pediatric group.
- Seven pediatric patients (23%) required reoperation due to calcific stenosis.
- Maximal calcification observed in postpubertal children under 17 years of age.
Conclusions:
- The Ionescu-Shiley valve is not currently recommended for pediatric use due to significant calcific stenosis.
- Mechanical valves have been reinstated for pediatric valve replacement in this institution.
- Further research is needed to address calcification issues in pediatric bioprosthetic valves.
Abstract:
Recognizing the problems of thromboembolism and anticoagulation in children and the high incidence of calcification in porcine valves in children, we hoped that the Ionescu-Shiley valve might be a good choice in the younger age group. We implanted 2,372 Ionescu-Shiley valves in 2,167 patients between 1978 and 1982, of which 30 were in children 16 years of age and younger. Although there have been no known instances of thromboembolism, valve infection, or valve disruption in this group of children, seven (23%) have already required reoperation for calcific stenosis. Although calcification appears maximal in postpubertal children less than 17 years of age, we consider it unwise currently to place these valves in any child and have returned to mechanical valves for this purpose.