Subscribe to RSS
DOI: 10.1055/s-2006-924627
© Georg Thieme Verlag KG Stuttgart · New York
Mechanical Aortic and Mitral Valve Replacement in Infants and Children
Publication History
received May 4, 2006
Publication Date:
05 April 2007 (online)
![](https://www.thieme-connect.de/media/thoracic/200703/lookinside/thumbnails/10.1055-s-2006-924627-1.jpg)
Abstract
Background: The aim of this study was to evaluate early and late outcomes after mechanical systemic heart valve replacement in pediatric patients. Methods: Between October 1981 and December 2003, 32 children (mean age 7.2 ± 5.4 years; 4 months - 15.9 years) underwent mechanical mitral (MVR, n = 17), aortic (AVR, n = 13) or double valve replacement (DVR, n = 2) with St. Jude Medical valves. Twenty-two patients (69 %) had undergone previous cardiac surgery. Anticoagulation self-management was used since 1995. Results: The operative mortality was 3.1 %. Perioperative complications were complete heart block (n = 5), ventricular fibrillation (n = 1) and myocardial infarction (n = 1) and were exclusively related to patients with MVR. Mean calculated valve size ratio (geometric prosthesis orifice area/normal valve size area) was 1.72 (1.07 - 2.85) for AVR and 1.4 (0.88 - 3.12) for MVR. Mean follow-up was 9.1 ± 6.6 years (range 0.4 - 23.2 years, cumulative 283 patient-years). There were two late deaths in patients with MVR. Actuarial survival after 10 years was 93.8 %. Late complications were endocarditis (n = 2), minor hemorrhagic event (n = 1), and stroke (n = 1). Anticoagulation self-management is well accepted by all patients/parents. Overall 10-year freedom from any anticoagulation-related adverse event with phenprocoumon was 89.1 % (1.2 %/patient year). Nine patients required reoperations: redo-MVR (outgrowth of prostheses (n = 3), pannus overgrowth (n = 2), closure of paravalvular leak after AVR (n = 2), partial aortic valve thrombosis (n = 1) and redo-DVR (n = 1 for endocarditis). Freedom from reoperation after 10 years was 80.9 %. Conclusions: Mechanical valve prostheses are a valuable option for left-sided heart valve replacement in pediatric patients. Perioperative morbidity was exclusively related to patients with MVR. Oversizing was often possible to avoid early reoperation for outgrowth. The operative mortality and long-term morbidity are acceptable. Anticoagulation self-management is safe and well accepted.
Key words
mechanical valve prostheses - mitral valve replacement - aortic valve replacement - congenital cardiac surgery
References
- 1 Gerosa G, McKay R, Davies J, Ross D N. Comparison of the aortic homograft and the pulmonary autograft for aortic valve or root replacement in children. J Thorac Cardiovasc Surg. 1991; 102 51-60
- 2 Clarke D R, Campbell D N, Hayward A R, Bishop D A. Degeneration of aortic valve allografts in young recipients. J Thorac Cardiovasc Surg. 1993; 105 934-942
- 3 Alexiou C, McDonald A, Langley S M, Dalrymple-Hay M JR, Haw P H, Monro J L. Aortic valve replacement in children: are mechanical prostheses a good option?. Eur J Cardiothorac Surg. 2000; 7 125-133
- 4 Champsaur G, Robin J, Tronc F. et al . Mechanical valve in aortic position is a valid option in children and adolescents. Eur J Cardiothorac Surg. 1997; 11 117-122
- 5 Cabalka A K, Emery R W, Petersen R J. et al . Long-term follow-up of the St. Jude Medical prosthesis in pediatric patients. Ann Thorac Surg. 1995; 60 S618-S623
- 6 Alexiou C, Galogavrou M, Chen Q. et al . Mitral valve replacement with mechanical prostheses in children: improved operative risk and survival. Eur J Cardiothorac Surg. 2001; 20 105-113
- 7 Caldarone C A, Raghuveer G, Hills C B. et al . Long-term survival after mitral valve replacement in children aged < 5 years. A multi-institutional study. Circul. 2001; 104 (Suppl I) I143-I147
- 8 Yoshimura N, Yamaguchi M, Oshima Y. et al . Surgery for mitral valve disease in the pediatric age group. J Thorac Cardiovasc Surg. 1999; 118 99-106
- 9 Masuda M, Kado H, Tatewaki H, Shiokawa Y, Yasui H. Late results after mitral valve replacement with bileaflet mechanical prosthesis in children: evaluation of prosthesis-patient mismatch. Ann Thorac Surg. 2004; 77 913-917
- 10 Reddy V M, Rajasinghe H A, Teitel D F, Haas G S, Hanley F L. Aortoventriculoplasty with the pulmonary autograft: the “Ross-Konno” procedure. J Thorac Cardiovasc Surg. 1996; 111 158-167
- 11 Elkins R C, Knott-Craig C J, Ward K E, McCue C, Lane M M. Pulmonary autograft in children: realized growth potential. Ann Thorac Surg. 1994; 57 1387-1394
- 12 Kirklin J W, Barratt-Boyes B G. Cardiac Surgery. New York, Edinburgh, London, Melbourne; Churchill Livingstone 1996
- 13 Gunther T, Mazzitelli D, Schreiber C, Wottke M, Paek S, Meisner H, Lange R. Mitral-valve replacement in children under 6 years of age. Eur J Cardiothorac Surg. 2000; 17 426-430
- 14 Lupinetti F M, Duncan B W, Scifres A M. et al . Intermediate-term results in pediatric aortic valve replacement. Ann Thorac Surg. 1999; 68 521-526
- 15 Turrentine M W, Ruzmetow M, Palaniswamy V, Bills R G, Brown J W. Biological versus mechanical aortic valve replacement in children. Ann Thorac Surg. 2001; 71 S356-S360
- 16 Van Doorn C, Yates R, Tsang V, de Leval M, Elliot M. Mitral valve replacement in children: mortality, morbidity and haemodynamic status up to medium term follow up. Heart. 2000; 84 636-642
- 17 Kadoba K, Jonas R A, Mayer J E, Castaneda A R. Mitral valve replacement in the first year of life. J Thorac Cardiovasc Surg. 1990; 100 762-768
- 18 Schaffer M S, Clarke D R, Campell D N, Madigan C K, Wiggins J W, Wolfe R R. The St. Jude Medical cardiac valve in infants and children: role of anticoagulant therapy. J Am Coll Cardiol. 1987; 9 235-239
- 19 Raghuveer G, Caldarone C A, Hills C B. et al . Predictors of prosthesis survival, growth, and functional status following mechanical mitral valve replacement in children aged less than 5 years, a multi-institutional study. Circul. 2003; 108 (Suppl II) II174-II179
- 20 Lupinetti F M, Warner J, Jones T K, Herndon S P. Comparison of human tissues and mechanical prostheses for aortic valve replacement in children. Circul. 1997; 96 321-325
- 21 Heneghan C, Alonso-Coello P, Garcia-Alamino J M, Perera R, Meats E, Glasziou P. Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet. 2006; 367 404-411
- 22 Christensen T D, Andersen N T, Maegard M, Hansen O K, Hjortdal V E, Hasenkam J M. Oral anticoagulation therapy in children: successfully controlled by self-management. Heart Surg Forum. 2004; 7 321-325
- 23 Hasenkam J M, Kimose H H, Knudsen L. et al . Self management of oral anticoagulant therapy after heart valve replacement. Eur J Cardiothorac Surg. 1997; 11 935-942
- 24 Schaefer C, Hannemann D, Meister R. et al . Vitamin K antagonists and pregnancy outcome. A multi-centre prospective study. Thromb Haemostat. 2006; 95 949-957
- 25 Kabbani S S, Jamil H, Hammoud A. et al . The mitral pulmonary autograft: assessment at midterm. Ann Thorac Surg. 2004; 78 60-66
- 26 Elkins R C, Knott-Craig C J, Ward E W, Lane M M. The Ross operation in children: 10-year experience. Ann Thorac Surg. 1998; 65 496-502
- 27 Ohye R G, Gomez C A, Ohye B J, Goldberg C S, Bove E L. The Ross/Konno procedure in neonates and infants: intermediate-term survival and autograft function. Ann Thorac Surg. 2001; 72 823-830
- 28 Cleveland D C, Williams W G, Razzouk A J. et al . Failure of cryopreserved homograft valved conduits in the pulmonary circulation. Circul. 1992; 86 (Suppl II) II150-II153
- 29 Stark J, Bull C, Stajevic M, Jothi M, Elliot M, de Leval M. Fate of subpulmonary homograft conduits: determinants of late homograft failure. J Thorac Cardiovasc Surg. 1998; 115 506-516
MD Jörg S. Sachweh
Pediatric Cardiac Surgery
University Hospital
Pauwelsstraße 30
52074 Aachen
Germany
Phone: + 49 24 18 08 05 24
Fax: + 49 24 18 08 24 78
Email: jsachweh@ukaachen.de