Mechanical aortic and mitral valve replacement in infants and children
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Mechanical aortic and mitral valve replacement in infants and children. / Sachweh, J S; Tiete, A R; Mühler, E G; Groetzner, J; Gulbins, H; Messmer, B J; Daebritz, S H.
In: THORAC CARDIOV SURG, Vol. 55, No. 3, 04.2007, p. 156-162.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Mechanical aortic and mitral valve replacement in infants and children
AU - Sachweh, J S
AU - Tiete, A R
AU - Mühler, E G
AU - Groetzner, J
AU - Gulbins, H
AU - Messmer, B J
AU - Daebritz, S H
PY - 2007/4
Y1 - 2007/4
N2 - 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.
AB - 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.
KW - Actuarial Analysis
KW - Adolescent
KW - Anticoagulants/adverse effects
KW - Aortic Valve
KW - Child
KW - Child, Preschool
KW - Female
KW - Follow-Up Studies
KW - Heart Valve Diseases/surgery
KW - Heart Valve Prosthesis Implantation/adverse effects
KW - Humans
KW - Infant
KW - Male
KW - Mitral Valve
KW - Postoperative Hemorrhage/etiology
KW - Prosthesis Failure
KW - Reoperation
KW - Thromboembolism/etiology
KW - Treatment Outcome
U2 - 10.1055/s-2006-924627
DO - 10.1055/s-2006-924627
M3 - SCORING: Journal article
C2 - 17410500
VL - 55
SP - 156
EP - 162
JO - THORAC CARDIOV SURG
JF - THORAC CARDIOV SURG
SN - 0171-6425
IS - 3
ER -
