Systemic mechanical heart valve replacement in children under 16 years of age

• Published in: Clinical research in cardiology Vol. 95; no. 5; pp. 281 - 288
• Main Authors: Tiete, A R, Sachweh, J S, Groetzner, J, Gulbins, H, Muehler, E G, Messmer, B J, Daebritz, S H
• Format: Journal Article
• Language: English
• Published: Germany Springer Nature B.V 01-05-2006
• Subjects: Adolescent; Anticoagulants; Aorta; Bioprosthesis; Cardiology; Catheters; Cerebral infarction; Child, Preschool; Children; Complications; Coronary artery disease; Digital video recorders; Endocarditis; Female; Heart attacks; Heart diseases; Heart Valve Diseases - surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Heart valves; Hemorrhage; Humans; Infant; Male; Mitral valve; Mortality; Myocardial infarction; Patients; Pediatrics; Prostheses; Prosthetics; Rheumatic heart disease; Surgery; Thromboembolism; Thrombosis; Treatment Outcome
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-006-0376-9

We report the early and late outcome following left-sided mechanical heart valve replacement in children. Between 10/1981 and 02/2001, 27 children (13 male, mean age 7.2 +/- 5.2 years, range 0.53-15.7 years) underwent mechanical mitral (MVR 16), aortic (AVR 9) or double valve replacement (DVR 2) with St. Jude Medical valves. Eighteen children (66.7%) had undergone previous cardiac surgery. Valve disease was congenital in 23, due to endocarditis in 2 and rheumatic in 2 patients. Concomitant cardiac surgery was performed in 12 patients (44.4%). Operative mortality was 3.7% (1/27). Perioperative complications were complete heart block (5) and myocardial infarction (1). Mean follow-up was 6.5+/-5.9 years (range 0.4-19 years, total 169.9 patient-years). There was one valve-related late death due to mitral valve thrombosis without phenprocoumon. Actuarial survival after 1, 5 and 10 years was 93, 93 and 93%. Late complications included endocarditis (2), minor hemorrhagic event (1) and stroke (1). Overall 10-year freedom from any anticoagulation-related adverse event under phenprocoumon was 91% (1.3%/patient year). Eight patients required reoperations: re-MVR (5; outgrowth of the prostheses (3), pannus overgrowth (2)), closure of paravalvular leak after AVR (2), and re- DVR (1; endocarditis). Actuarial freedom from reoperation after 1, 5 and 10 years was 96, 88 and 76%.
Mechanical valve prostheses are a valuable option for left-sided heart valve replacement in pediatric patients with good results. Operative mortality and the incidence of any valve-related events as endocarditis, reoperation, thromboembolism or anticoagulation related bleeding is acceptable.