In order to analyze the problems associated with prosthetic valve replacement (PVR) in the pediatric population, we have reviewed 29 children, 3.5 to 15 years of age, who were operated upon from 1970 to 1986. The indications were congenital valve malformations in 16 patients, rheumatic valve disease in 7, degenerative disease in 2 and bacterial endocarditis in 4. Ten children underwent aortic valve replacement (AVR), 14 mitral valve replacement (MVR), 1 tricuspid valve replacement and 4 double valve replacement (mitral-aortic in 3 and mitral-tricuspid in 1). Twenty-one mechanical (11 aortic and 10 mitral) and 12 biological prostheses (8 mitral, 2 aortic, and 2 tricuspid) were implanted. There was 1 hospital death (3.4%). Follow-up data were available for all survivors from 3 to 184 months. There were 8 late deaths (5.9% patient-year), 4 among children with mechanical and 4 among those with biological prostheses. Overall actuarial survival at 14 years is 62.5 ± 10.2% with no significant difference in survival between AVR (77.8 ± 14%) and MVR (44.4 ± 16%) (p = 0.31) at 10 years and between recipients of mechanical (65.7 ± 13%) or biological prostheses (60.0 ± 15%) (p = 0.62) at 6 years. No documented embolic or anticoagulant-related complications occurred in the entire series. Actuarial freedom from reoperation is 55.6 ± 16% at 5 years and 27.8 ± 16% at 10 years for children with a biological prosthesis and 100% at 6 years for those with a mechanical prosthesis. Our results justify PVR in children when any attempt to preserve the native valve proves unsuccessful. In such case tilting disc or bileaflet mechanical prostheses are currently preferred by us in the pediatric age group.

Valve replacement in children: early and late results.

STELLIN, GIOVANNI;RIZZOLI, GIULIO;DALIENTO, LUCIANO;
1989

Abstract

In order to analyze the problems associated with prosthetic valve replacement (PVR) in the pediatric population, we have reviewed 29 children, 3.5 to 15 years of age, who were operated upon from 1970 to 1986. The indications were congenital valve malformations in 16 patients, rheumatic valve disease in 7, degenerative disease in 2 and bacterial endocarditis in 4. Ten children underwent aortic valve replacement (AVR), 14 mitral valve replacement (MVR), 1 tricuspid valve replacement and 4 double valve replacement (mitral-aortic in 3 and mitral-tricuspid in 1). Twenty-one mechanical (11 aortic and 10 mitral) and 12 biological prostheses (8 mitral, 2 aortic, and 2 tricuspid) were implanted. There was 1 hospital death (3.4%). Follow-up data were available for all survivors from 3 to 184 months. There were 8 late deaths (5.9% patient-year), 4 among children with mechanical and 4 among those with biological prostheses. Overall actuarial survival at 14 years is 62.5 ± 10.2% with no significant difference in survival between AVR (77.8 ± 14%) and MVR (44.4 ± 16%) (p = 0.31) at 10 years and between recipients of mechanical (65.7 ± 13%) or biological prostheses (60.0 ± 15%) (p = 0.62) at 6 years. No documented embolic or anticoagulant-related complications occurred in the entire series. Actuarial freedom from reoperation is 55.6 ± 16% at 5 years and 27.8 ± 16% at 10 years for children with a biological prosthesis and 100% at 6 years for those with a mechanical prosthesis. Our results justify PVR in children when any attempt to preserve the native valve proves unsuccessful. In such case tilting disc or bileaflet mechanical prostheses are currently preferred by us in the pediatric age group.
1989
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/2520070
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