Aortic and mitral valve replacement in children: is there any role for biologic and bioprosthetic substitutes?

نویسندگان

  • Bahaaldin Alsoufi
  • Cedric Manlhiot
  • Brian W McCrindle
  • Charles C Canver
  • Ahmed Sallehuddin
  • Saud Al-Oufi
  • Mansour Joufan
  • Zohair Al-Halees
چکیده

OBJECTIVE The ideal valve substitute in children does not exist. Biologic and bioprosthetic valves do not require anticoagulation, however their use is complicated by accelerated degeneration and requirement for reoperation. We examine results following mitral (MVR) or aortic (AVR) replacement with biologic and bioprosthetic valves at our institution. METHODS Medical records of children who underwent AVR or MVR from 1986 to 2006 were reviewed. Median follow-up duration was 10.5 years. Competing-risks methodology determined time-related prevalence and associated factors for three mutually exclusive end states: death, valve reoperation, and survival without subsequent reoperation. RESULTS One hundred and ten children (age 15.6+/-2.6 years, 80% females) underwent 123 valve replacements with biologic and bioprosthetic substitutes including 87 MVR and 36 AVR (13 had both). Underlying pathology was mainly rheumatic fever (91%). Thirty-nine patients (35%) had undergone a previous cardiac surgery. Most common mitral substitute was Hancock (73%) and homograft (8%); most common aortic substitute was homograft (41%) and Carpentier-Edwards (39%). Competing-risks analysis showed that 15 years after valve replacement, 16% of patients had died without subsequent reoperation, 66% underwent valve reoperations, and only 18% remained alive without further reoperation. Factors associated with increased reoperation risk included younger age at surgery (p=0.005), AVR (p=0.005), male gender (p=0.02) and homograft use (p=0.007) especially in the mitral position (p=0.002). Fifteen-year freedom from endocarditis was 97% while freedom from bleeding and thrombo-embolic complications was 100%. Majority of patients (95%) were in NYHA functional classes I/II at last follow-up. CONCLUSION While valve reoperation is inevitable following AVR and MVR with biologic and bioprosthetic substitutes; favorable results such as low valve-related morbidity rate, good long-term survival and functional status encourage their consideration as valid replacement alternatives in selected children especially females. Valve durability is higher in the mitral position and longevity of bioprosthetic valves is greater than that of homografts especially in the mitral position.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Trans-catheter Bioprosthetic Heart Valve Implantation in Iran (Tehran Heart Centre Experience)

Introduction: With the development of interventional cardiology in the world, in addition to coronary and aortic diseases, the treatment of heart valve diseases through catheters has recently begun. The treatment of aortic stenosis (which was only possible with open surgery and valve replacement) was first performed in the world in 2002 by Alain Cribier in France with catheter insertion of the ...

متن کامل

بررسی 290 کودک مبتلا به بیماری دریچه‌ای قلبی روماتیسمی

    Background & Aim: Acute rheumatic fever and its cardiac involvement is one of the most prevalent acquired pediatric heart diseases in developing countries needing long hospitalization, cardiac surgery, prophylaxis, and delicate management and causing death in some cases. A paucity of information about this disease in our country made us perform the present study in one of the largest pediat...

متن کامل

Successful Use of Two Thrombolytic Drugs in Prosthetic Mitral and Aortic Valve Thrombosis

Introduction: Prosthetic valve thrombosis is a rare and severe complication of valve replacement, most often encountered with a mechanical prosthesis. The significant morbidity and mortality associated with this condition warrant rapid diagnostic evaluation. Although surgery is the first-line therapy in symptomatic obstructive mechanical valve thrombosis, thrombolytic therapy has been used as a...

متن کامل

New Ways of Thinking About Senescent Bioprosthetic Heart Valve Therapy.

SEE PAGE 1735 I n patients requiring heart valve replacement, biologic valve substitutes have been implanted with increasing frequency over the past decade. According to the Society of Thoracic Surgeons (STS) database, bioprosthetic valve implants in the aortic position have increased from 43.6% in 1997 to 78.4% in 2006 (1). A similar trend has been seen for mitral valve replacement (2). The tr...

متن کامل

Double Valve Replacement (Mitral and Aortic) for Rheumatic Heart Disease: A 20-year experience with 300 patients.

Introduction: Rheumatic heart disease still remains one of the leading causes of congestive heart failure and death owing to valvular pathologies, in developing countries. Valve replacement still remains the treatment of choice in such patients.The aim of this study wasto analyze the postoperative outcome of  double valve replacement (Mitral and Aortic ) in patients of rheumatic heart disease. ...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

دوره 36 1  شماره 

صفحات  -

تاریخ انتشار 2009