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Mechanical valve replacement in congenital heart disease
A E Fiane1, H L Lindberg, K Saatvedt
1Department of Cardiothoraclc Surgery, Rikshospitalet, University of Oslo, Norway.
The Journal of Heart Valve Disease
|May 1, 1996
Summary
Mechanical valve replacement in children with congenital heart disease showed good long-term survival for aortic valve replacement but significant risks for atrioventricular valves. Warfarin plus antiplatelet drugs are now recommended for atrioventricular valve implantation.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Mechanical valves are standard for pediatric valve replacement.
- Somatic growth poses challenges like patient-valve mismatch.
- Optimal anticoagulation regimens remain debated.
Purpose of the Study:
- To evaluate the long-term outcomes of mechanical valve replacement in a pediatric population.
- To assess survival rates, complications, and the efficacy of anticoagulation.
Main Methods:
- A retrospective review of 48 pediatric patients (mean age 11.2 years) undergoing mechanical valve replacement between 1972 and 1992.
- Analysis of valve types, positions, early mortality, and long-term follow-up (mean 8.3 years).
- Evaluation of complications including thrombosis, leaks, endocarditis, and bleeding events.
Main Results:
- Overall survival after 10 years was 81% for aortic valve replacement and 33% for mitral valve replacement.
- Major complications included paravalvular leak (1.5%/pty) and valve thrombosis (1.3%/pty).
- Thromboembolic and hemorrhagic events were generally minor (0.8%/pty each).
Conclusions:
- Mechanical prostheses in pediatric congenital heart disease are associated with significant morbidity and mortality.
- Long-term survival after aortic valve replacement is favorable.
- Atrioventricular valve replacement carries a higher risk of thrombosis; combined warfarin and antiplatelet therapy is now advised.