Performance of Mechanical Valves in Pediatric Patients
Mechanical cardiac valve replacement was performed in 182 patients, age 15 years and younger, from May 1980 to July 1985. All patients belonged to a relatively underdeveloped population group. Twelve patients (6.5%) died in the perioperative period. One hundred forty-seven patients were followed up for 604 patient-years. There were 26 late deaths, of which 5 were known to be valve-related, 7 cardiac non-valve-related, 1 noncardiac, and 12 unknown. The linearized incidences for valve-related complications were: valve failure (valve-related mortality and reoperation) 4.3% per patient-year; thromboembolism 1.7% per patient-year; thrombotic obstruction 1.7% per patient-year; bacterial endocarditis 1.3% per patient-year; bland paravalvular leak 0.8% per patient-year; and anticoagulant-related hemorrhage 0.3% per patient-year. In actuarial analysis, 96% of patients were free of valve-related mortality at 5 years. The corresponding figures were: freedom from valve failure 80%; thrombotic obstruction 91%; thromboembolism 81%; and reoperations 84%. The performance of mechanical valves in children was superior to that of tissue valves but similar to that in adults. Therefore, we believe that mechanical prostheses should be used in these patients whenever the natural valves cannot be preserved.