Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-18T14:45:54.815Z Has data issue: false hasContentIssue false
  • English
  • Français

Medium-term follow-up of mechanical valves inserted in children

Published online by Cambridge University Press:  20 November 2006

Signe Holm Larsen ,
Kim Houlind ,
Ole Kromann Hansen ,
Kirsten Hjortholm ,
Kristian Emmertsen  and
Vibeke Hjortdal
Signe Holm Larsen
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
Kim Houlind
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
Ole Kromann Hansen
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
Kirsten Hjortholm
Affiliation:
Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
Kristian Emmertsen
Affiliation:
Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark
Vibeke Hjortdal
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: We reviewed our experience with mechanical valves inserted between 1988 and 2002 in children aged 15 years or younger. Methods: Hospital files were extracted retrospectively. Follow-up was completed by March 2005. Results: Of 41 patients, we inserted a valve in atrioventricular position in 27 children, having a median age of 3.1 years, ranging from 0.4 to 14.5 years, and in aortic position in the remaining 14, having a median age of 13.5 years, and a range from 7.0 to 14.9 years. For the valves inserted in atrioventricular position, the underlying disease was congenital in 23, rheumatic in two, post-endocarditic in one, and Marfan's syndrome in one. Mean follow-up was 7.7 years, with standard deviation of 5.3, giving a total follow-up of 209 patient years. Mortality at 30 days was 7%, and survival was 73% at up to 16 years follow-up. Events related to anticoagulation were seen in 3 patients, corresponding to 1.4% per patient year. In 6 patients (22%), heart block ensued which required implantation of a pacemaker treatment, and 5 patients (19%) had reoperations. For the implantations in aortic position, the underlying disease was congenital in 13, stenosis in 10 and insufficiency in three, and post-endocarditis in one. Mean follow-up was 6.8 years, with standard deviation of 4.6, giving a total of 95 patient years. We lost one patient within 30 days (7.7% mortality), and survival was 77% at up to 13 years follow-up. There were no incidents of thrombosis, nor events related to anticoagulation, but one patient (7%) needed insertion of a pacemaker due to a perioperative heart block, and one (7%) required new valvar replacement. Conclusions: Although preferably avoided, mechanical valves can be implanted in children with an acceptable mortality and morbidity, and good long-term results.

Keywords

Mechanical prosthesescongenital heart diseaseatrioventricular valveaortic valve
Type
Original Article
Information
Cardiology in the Young , Volume 16 , Issue 6 , December 2006 , pp. 579 - 585
Copyright
© 2006 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Chauvaud S, Fuzellier JF, Houel R, Berrebi A, Mihaileanu S, Carpentier A. Reconstructive surgery in congenital mitral valve insufficiency (Carpentier's techniques): long-term results. J Thorac Cardiovasc Surg 1998; 115: 84–92.Google Scholar
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.Google Scholar
Gunther T, Mazzitelli D, Schreiber C, et al. Mitral-valve replacement in children under 6 years of age. Eur J Cardiothorac Surg 2000; 17: 426–430.Google Scholar
Mazzitelli D, Guenther T, Schreiber C, Wottke M, Michel J, Meisner H. Aortic valve replacement in children: are we on the right track? Eur J Cardiothorac Surg 1998; 13: 565–571.Google Scholar
Christensen TD, Andersen NT, Maegaard M, Hansen OK, Hjortdal VE, Hasenkam JM. Oral anticoagulation therapy in children: successfully controlled by self-management. Heart Surg Forum 2004; 7: E321–E325.Google Scholar
Edmunds LH Jr., Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. Guidelines for reporting morbidity and mortality after cardiac valvular operations. The American Association for Thoracic Surgery, Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Ann Thorac Surg 1996; 62: 932–935.Google Scholar
Caldarone CA, Raghuveer G, Hills CB, et al. Long-term survival after mitral valve replacement in children aged <5 years: a multi-institutional study. Circulation 2001; 104: I143–I147.Google Scholar
Stewart S, Cianciotta D, Alexson C, Manning J. The long-term risk of warfarin sodium therapy and the incidence of thromboembolism in children after prosthetic cardiac valve replacement. J Thorac Cardiovasc Surg 1987; 93: 551–554.Google Scholar
Buck ML. Anticoagulation with warfarin in infants and children. Ann Pharmacother 1996; 30: 1316–1322.Google Scholar
van Doorn C, Yates R, Tsang V, deLeval M, Elliott M. Mitral valve replacement in children: mortality, morbidity, and haemodynamic status up to medium term follow up. Heart 2000; 84: 636–642.Google Scholar
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.Google Scholar
Alexiou C, McDonald A, Langley SM, Dalrymple-Hay MJ, Haw MP, Monro JL. Aortic valve replacement in children: are mechanical prostheses a good option? Eur J Cardiothorac Surg 2000; 17: 125–133.Google Scholar
Lupinetti FM, Duncan BW, Scifres AM, et al. Intermediate-term results in pediatric aortic valve replacement. Ann Thorac Surg 1999; 68: 521–525.Google Scholar
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.Google Scholar
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.Google Scholar
Kojori F, Chen R, Caldarone CA, et al. Outcomes of mitral valve replacement in children: a competing-risks analysis. J Thorac Cardiovasc Surg 2004; 128: 703–709.Google Scholar
Ibrahim M, Cleland J, O'Kane H, Gladstone D, Mullholland C, Craig B. St. Jude Medical prosthesis in children. J Thorac Cardiovasc Surg 1994; 108: 52–66.Google Scholar
Lubiszewska B, Rozanski J, Szufladowicz M, et al. Mechanical valve replacement in congenital heart disease in children. J Heart Valve Dis 1999; 8: 74–79.Google Scholar