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[Aortic valve replacement in children]
E Saro-Servando1, S Vobecky, C Chartrand
1Service de Chirurgie Cardiovasculaire, Hôpital Sainte-Justine, Côte Sainte-Catherine, Montréal, Québec, Canada.
Insights
Pediatric aortic valve replacement shows excellent outcomes for isolated procedures. However, combining valve replacement with major cardiac surgery significantly increases hospital mortality risks in children.
Area of Science:
- Pediatric Cardiac Surgery
- Valvular Heart Disease Management
- Biomedical Engineering (Prosthetic Valves)
Context:
- Aortic valve replacement (AVR) in children presents unique challenges due to congenital defects and prior interventions.
- From 1970-1993, 47 pediatric AVRs were analyzed, with 39 cases of congenital valvular pathology.
- Many patients had associated cardiac anomalies or previous aortic outflow surgeries.
Purpose:
- To evaluate the outcomes of aortic valve replacement in pediatric patients.
- To compare results of isolated AVR versus AVR combined with major cardiac procedures.
- To assess the long-term durability and complications of different prosthetic valve types in children.
Summary:
- 47 children underwent AVR (1970-1993); 7 bioprostheses and 40 mechanical valves were used.
- Isolated AVR had no hospital deaths, while combined procedures with major cardiac surgery had a 41% mortality rate (7/17).
- Late outcomes included 3 deaths, 3 reoperations (2 for bioprosthetic degeneration), 1 thromboembolic event, and 1 hemolytic anemia episode.
Impact:
- Isolated AVR in children yields excellent results, with low morbidity and mortality.
- Combined AVR and major cardiac procedures carry substantial hospital mortality risk.
- Bioprosthetic valves are contraindicated in children due to rapid degeneration; mechanical valves are preferred.
Abstract:
From January 1970 to January 1993, 47 aortic valve replacements have been performed in children aged 166.8 +/- 50 months. The valvular pathology was congenital in 39 patients and associated cardiac anomalies were present in 31 cases. 30 children had a previous surgical procedure on the aortic outflow. Seven bioprosthesis and 40 mechanical valves have been implanted. At the time of surgery, an additional major cardiac correction has been performed on 17 occasions (Konno, Bentall, Fontan, correction of truncus arteriosus etc.). While no death occurred in the group subjected only to aortic valve replacement, 7 of the 17 patients where a major cardiac procedure was added died. During a mean follow-up of 61.2 +/- 59.1 months, 3 late deaths occurred, 2 of them non related to valvular surgery. Three reoperations have been performed, in two instances for replacing a degenerated bioprosthesis. One thromboembolic event occurred as well as one temporary episode of haemolytic anaemia. No haemorrhagic complication has been observed. While the results of isolated aortic valve replacement in children are excellent, the risk for hospital death is increased substantially when a major cardiovascular procedure is added to valve replacement, and because of rapid deterioration, the heterografts are now contra-indicated in children.