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Comparison of mechanical and biological prostheses when used to replace heart valves in children and adolescents with rheumatic fever

Published online by Cambridge University Press:  01 April 2009

Paulo R. Travancas ,
Ana H. Dorigo ,
Luiz C. Simões ,
Sandra C. Fonseca ,
Kátia V. Bloch  and
Gesmar V. Herdy
Paulo R. Travancas*
Affiliation:
Serviço de Cardiologia da Criança e do Adolescente do Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Ana H. Dorigo
Affiliation:
Serviço de Cardiologia da Criança e do Adolescente do Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Luiz C. Simões
Affiliation:
Serviço de Cardiologia da Criança e do Adolescente do Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Sandra C. Fonseca
Affiliation:
Departamento de Epidemiologia e Bioestatística da Universidade Federal Fluminense, Niterói, Brazil
Kátia V. Bloch
Affiliation:
Departamento de Medicina Preventiva da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
Gesmar V. Herdy
Affiliation:
Departamento de Pediatria da Faculdade de Medicina da Universidade Federal Fluminense, Niterói, Brazil
*
Correspondence to: Paulo Renato Figueiredo Travancas, Serviço de Cardiologia da Criança e do Adolescente do Instituto Nacional de Cardiologia, Rua das Laranjeiras 374 4° floor, Laranjeiras, Rio de Janeiro – RJ, BrazilCEP 22240-006. Tel & Fax: 00 55 21 22854594; E-mail: [email protected]
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Abstract

Objective

To assess the outcomes in children and adolescents with rheumatic fever of the implantation of mechanical as opposed to biological heart valves.

Methods

We assessed 73 patients with rheumatic heart disease under the age of 18 years, who underwent replacement of heart valves between January, 1996, and December, 2005, at the National Institute of Cardiology in Rio de Janeiro, Brazil. Of the group, 71 patients survived, and were divided into a group of 52 receiving mechanical prostheses, and 19 with biological prostheses. We compared endpoints between the groups in terms of mortality, reoperation, haemorrhage, and stroke. Survival curves were estimated using the Kaplan-Meier method and were compared by the Mantel (log-rank) test.

Results

Overall mortality was 8.2%. In those receiving mechanical prostheses, 2 (3.8%) patients died, 5 (9.6%) underwent reoperation, 2 (3.8%) suffered severe haemorrhage, and 3 (5.8%) had strokes. In those receiving biological valves, 2 (10.5%) patients died, and 4 (21%) underwent reoperation. After 2, 4, and 8 years, overall survival was 96%, 93% and 86%, respectively, with a borderline difference between the groups (p = 0.06). The probabilities of remaining free from reoperation (p = 0.13), and from combined endpoints, showed no statistically significant difference between the groups (p = 0.28).

Conclusions

Patients with mechanical prostheses had lower mortality and required fewer reoperations, but when all combined endpoints were considered, the groups did not differ. The biological prosthesis proved to be a good option for cardiac surgery in children and adolescents with difficulties or risks of anticoagulation.

Keywords

Cardiothoracic surgerypaediatric cardiac surgeryrheumatic heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 19 , Issue 2 , April 2009 , pp. 192 - 197
Copyright
Copyright © Cambridge University Press 2009

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References

1.Mota, CC. Rheumatic fever in the 21st century. Cardiol Young 2003; 13: 491–494.CrossRefGoogle Scholar
2.Kaplan, EL, Markowitz, M. The fall and rise of rheumatic fever in the United States: a commentary. Int J Cardiol 1988; 21: 3–10.CrossRefGoogle ScholarPubMed
3.Kaplan, EL. Rheumatic fever at the end of the twentieth century: why is there still a problem? Cardiol Young 1992; 2: 204–205.CrossRefGoogle Scholar
4.Meira, ZM, Castilho, SR, Barros, MV, et al. Prevalência da febre reumática em crianças de uma escola de rede pública de Belo Horizonte. Arq Bras Cardiol 1995; 65: 331–334.Google Scholar
5.www.datasus.gov.br. Accessed on 11/1/2007.Google Scholar
6.Meira, ZM, Goulart, EM, Colosimo, EA, Mota, CC. Long term follow-up of rheumatic fever and predictors of severe rheumatic valvar disease in Brazilian children and adolescents. Heart 2005; 91: 1019–1022.CrossRefGoogle ScholarPubMed
7.Bonow, RO, Carabello, BA, Chatterjee, K, et al. ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease. JACC 2006; 48: 1–148.CrossRefGoogle ScholarPubMed
8.Borman, JB, Shimon, DV, Deeb, M, Simcha, A. Valve replacement in children. J Card Surg 1989; 4: 260–281.CrossRefGoogle ScholarPubMed
9.Burdon, TA, Miller, DC, Oyer, PE, et al. Durability of porcine valves fifteen years in a representative North American patient population. J Thorac Cardiovasc Surg 1992; 103: 238–251.CrossRefGoogle Scholar
10.Antunes, MJ. Bioprosthetic valve replacementin children: Long-term follow-up with 135 mitral valve implantations. Eur Heart J 1984; 5: 913–918.CrossRefGoogle Scholar
11.John, S, Ravikumar, E, Jairaj, PS, Chowdhury, U, Krishnaswami, S. Valve replacement in the young patient with rheumatic heart disease. Review of a twenty-year experience. J Thorac Cardiovasc Surg 1990; 99: 631–638.CrossRefGoogle Scholar
12.Criteria Committee, New York Heart Association, Inc.. Diseases of the Heart and Blood Vessels. Nomenclature and Criteria for Diagnosis, 6th edn., Little, Brown and Co., Boston, 1964, p 114.Google Scholar
13.Atik, FA, Pomerantzeff, PM, Dias, AR, Barbero-Marcial, M, Stolf, NA, Jatene, AD. Evolução imediata e tardia das substituições valvares em crianças menores de 12 anos de idade. Arq Bras Cardiol 1999; 73: 419–423.Google Scholar
14.Robbins, RC, Bowman, FO, Malm, JR. Cardiac valve replacement in children: a twenty-year series. Ann Thorac Surg 1988; 45: 56–61.CrossRefGoogle ScholarPubMed
15.Vosa, C, Renzulli, A, Lombardi, PF, Damiani, G. Mechanical valve replacement under 12 years of age: 15 years of experience. J Heart Valve Dis 1995; 4: 279–283.Google ScholarPubMed
16.Antunes, MJ, Vanderdonck, KM, Sussman, MJ. Mechanical valve replacement in children and teenagers. Eur J Cardiothorac Surg 1989; 3: 222–228.CrossRefGoogle ScholarPubMed
17.Tiete, AR, Sachweh, JS, Groetzner, J, et al. Systemic mechanical heart valve replacement in children under 16 years of age. Clin Res Cardiol 2006; 95: 281–288.CrossRefGoogle ScholarPubMed
18.Ibrahim, M, Cleland, J, O’Kane, H, Gladstone, D, Mullholland, C, Craig, B. St. Jude medical prosthesis in children. A thirteen-year experience. J Thorac Cardiovasc Surg 1994; 108: 221–230.CrossRefGoogle ScholarPubMed
19.Solymar, L, Rao, PS, Mardini, MK, Fawzy, ME, Guinn, G. Prosthetic valves in children and adolescents. Am Heart J 1991; 121: 557–568.CrossRefGoogle ScholarPubMed
20.Godoy, MF, Branco, JNR, Soares, HC, et al. Resultados a longo prazo da substituição valvar em crianças. Arq Bras Cardiol 1981; 37: 325–329.Google Scholar
21.Salles, CA, Christo, MC, Stortini, MJ, et al. Resultados iniciais com a bioprótese heteróloga de Carpentier-Edwards. Arq Bras Cardiol 1981; 36: 349–352.Google Scholar
22.Harada, Y, Imai, Y, Kurosawa, H, Ishihara, K, Kawada, M, Fukuchi, S. Ten-year follow-up after valve replacement with the St. Jude medical prosthesis in children. J Thorac Cardiovasc Surg 1990; 100: 175–180.CrossRefGoogle ScholarPubMed
23.Hammermeister, K, Sethi, GK, Henderson, WG, Grover, FL, Oprian, C, Rahimtoola, SH. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol 2000; 36: 1152–1158.CrossRefGoogle ScholarPubMed
24.Bloomfield, P, Wheatley, DJ, Prescott, RJ, Miller, HC. Twelve-year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses. N Engl J Med 1991; 324: 624–626.CrossRefGoogle ScholarPubMed
25.Antunes, MJ. Bioprosthetic valve replacement in children: long-term follow-up with 135 mitral valve implantations. Eur Heart J 1984; 5: 913–918.CrossRefGoogle ScholarPubMed
26.Abid, F, Mzah, N, Euch, FE, Ismail, MB. Valve replacement in children under 15 years with rheumatic heart disease. Pediatr Cardiol 1989; 10: 199–204.CrossRefGoogle ScholarPubMed
27.Bloomfield, P. Choice of heart valve prosthesis. Heart 2002; 87: 583–589.CrossRefGoogle ScholarPubMed
28.Butchart, EG, Moreno de la Santa, P, Rooney, SJ, Lewis, PA. The role of risk factors and trigger factors in cerebrovascular events after mitral valve replacement: implications for antithrombotic management. J Card Surg 1994; 9 (Suppl.): 228–236.CrossRefGoogle ScholarPubMed
29.Cabalka, AK, Emery, RW, Petersen, RJ, et al. Long-term follow-up of the St. Jude medical prosthesis in pediatric patients. Ann Thorac Surg 1995; 60: 618–623.CrossRefGoogle ScholarPubMed
30.Rao, PS, Solymar, L, Fawzy, ME, Guinn, G. Reassessment of usefulness of porcine heterograft in mitral position in children. Pediatr Cardiol 1991; 12: 164–169.CrossRefGoogle ScholarPubMed
31.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.CrossRefGoogle ScholarPubMed
32.Van Doorn, C, Yates, R, Elliot, M, deLeval, M, Elliott, M. Mitral valve replacement in children: mortality, morbidity and hemodynamic status up to medium term follow-up. Heart 2000; 84: 636–642.CrossRefGoogle ScholarPubMed