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Thorac Cardiovasc Surg 2007; 55(3): 156-162
DOI: 10.1055/s-2006-924627
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Mechanical Aortic and Mitral Valve Replacement in Infants and Children

J. S. Sachweh1 , 3 , A. R. Tiete1 , 3 , E. G. Mühler2 , J. Groetzner1 , 3 , H. Gulbins3 , B. J. Messmer1 , S. H. Daebritz1 , 3
  • 1Department of Thoracic and Cardiovascular Surgery, Pediatric Cardiac Surgery, RWTH Aachen University Hospital, Aachen, Germany
  • 2Department of Pediatric Cardiology, RWTH Aachen University Hospital, Aachen, Germany
  • 3Cardiac Surgery, University Hospital Großhadern, Munich, Germany
Further Information

Publication History

received May 4, 2006

Publication Date:
05 April 2007 (online)

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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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Kirklin J W, Barratt-Boyes B G. Cardiac Surgery. New York, Edinburgh, London, Melbourne; Churchill Livingstone 1996
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 25 Kabbani S S, Jamil H, Hammoud A. et al . The mitral pulmonary autograft: assessment at midterm.  Ann Thorac Surg. 2004;  78 60-66
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

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

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