Skip to main content
SpringerLink
Log in

Systemic mechanical heart valve replacement in children under 16 years of age

  • ORIGINAL PAPER
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Summary

We report the early and late outcome following left-sided mechanical heart valve replacement in children. Between 10/1981 and 02/2001, 27 children (13 male, mean age 7.2 ± 5.2 years, range 0.53–15.7 years) underwent mechanical mitral (MVR 16), aortic (AVR 9) or double valve replacement (DVR 2) with St. Jude Medical valves. Eighteen children (66.7%) had undergone previous cardiac surgery. Valve disease was congenital in 23, due to endocarditis in 2 and rheumatic in 2 patients. Concomitant cardiac surgery was performed in 12 patients (44.4%). Operative mortality was 3.7% (1/27). Perioperative complications were complete heart block (5) and myocardial infarction (1). Mean follow-up was 6.5±5.9 years (range 0.4–19 years, total 169.9 patient-years). There was one valve-related late death due to mitral valve thrombosis without phenprocoumon. Actuarial survival after 1, 5 and 10 years was 93, 93 and 93%. Late complications included endocarditis (2), minor hemorrhagic event (1) and stroke (1). Overall 10-year freedom from any anticoagulation-related adverse event under phenprocoumon was 91% (1.3%/patient year). Eight patients required reoperations: re-MVR (5; outgrowth of the prostheses (3), pannus overgrowth (2)), closure of paravalvular leak after AVR (2), and re- DVR (1; endocarditis). Actuarial freedom from reoperation after 1, 5 and 10 years was 96, 88 and 76%.

Conclusion

Mechanical valve prostheses are a valuable option for left-sided heart valve replacement in pediatric patients with good results. Operative mortality and the incidence of any valve-related events as endocarditis, reoperation, thromboembolism or anticoagulation related bleeding is acceptable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gerosa G, McKay R, Davies J, Ross DN (1991) Comparison of the aortic homograft and the pulmonary autograft for aortic valve or root replacement in children. J Thorac Cardiovasc Surg 102:51–6

    CAS  PubMed  Google Scholar 

  2. Clarke DR, Campbell DN, Hayward AR, Bishop DA (1993) Degeneration of aortic valve allografts in young recipients. J Thorac Cardiovasc Surg 105:934–942

    CAS  PubMed  Google Scholar 

  3. Alexiou C, McDonald A, Langley SM, Dalrymple-Hay MJR, Haw PH, Monro JL (2000) Aortic valve replacement in children: are mechanical prostheses a good option? Eur J Cardiothorac Surg 17:125–133

    Article  CAS  PubMed  Google Scholar 

  4. Champsaur G, Robin J, Tronc F, Curtil A, Ninet J, Sassolas F, Vedrinne C, Bozio A (1997) Mechanical valve in aortic position is a valid option in children and adolescents. Eur J Cardiothorac Surg 11:117–122

    Article  CAS  PubMed  Google Scholar 

  5. Cabalka AK, Emery RW, Petersen RJ, Helseth HK, Jakkula M, Arom KV, Nicoloff DM. Long-term follow-up of the St. Jude Medical prosthesis in pediatric patients (1995) Ann Thorac Surg 60:S618–623

    Article  CAS  PubMed  Google Scholar 

  6. Alexiou C, Galogavrou M, Chen Q, McDonald A, Salmon AP, Keeton BK, Haw MP, Monro JL (2001) Mitral valve replacement with mechanical prostheses in children: improved operative risk and survival. Eur J Cardiothorac Surg 20:105–113

    Article  CAS  PubMed  Google Scholar 

  7. Caldarone CA, Raghuveer G, Hills CB, Atkins DL, Burns TL, Behrendt DM, Moller JH (2001) Long-term survival after mitral valve replacement in children aged <5 years. A multiinstitutional study. Circulation 104 (suppl I):143–147

    Google Scholar 

  8. Yoshimura N, Yamaguchi M, Oshima Y, Oka S, Ootaki Y, Murakami H, Tei T, Ogawa K (1999) Surgery for mitral valve didease in the pediatric age group. J Thorac Cardiovasc Surg 118:99–106

    Article  CAS  PubMed  Google Scholar 

  9. Masuda M, Kado H, Tatewaki H, Shiokawa Y, Yasui H (2004) Late results after mitral valve replacement with bileaflet mechanical prosthesis in children: evaluation of prosthesis-patient mismatch. Ann Thorac Surg 77:913–917

    Article  PubMed  Google Scholar 

  10. Reddy VM, Rajasinghe HA, Teitel DF, Haas GS, Hanley FL (1996) Aortoventriculoplasty with the the pulmonary autograft: the “Ross-Konno” procedure. J Thorac Cardiovasc Surg 111:158–67

    Article  CAS  PubMed  Google Scholar 

  11. Elkins RC, Knott-Craig CJ, Ward KE, McCue C, Lane MM (1994) Pulmonary autograft in children: realized growth potential. Ann Thorac Surg 57:1387–1394

    Article  CAS  PubMed  Google Scholar 

  12. Turrentine MW, Ruzmetow M, Palaniswamy V, Bills RG, Brown JW (2001) Biological versus mechanical aortic valve replacement in children. Ann Thorac Surg 71:S356–360

    Article  CAS  PubMed  Google Scholar 

  13. Lupinetti FM, Duncan BW, Scifres AM, Fearneyhough CT, Kilian K, Rosenthal GL, Cecchin F, Jones TK, Herndon SP (1999) Intermediate-term results in pediatric aortic valve replacement. Ann Thorac Surg 68:521–526

    Article  CAS  PubMed  Google Scholar 

  14. Van Doorn C, Yates R, Tsang V, de Leval M, Elliot M (2000) Mitral valve replacement in children: mortality, morbidity and hemodynamic status up to medium term follow up. Heart 84:636–642

    Article  CAS  PubMed  Google Scholar 

  15. Lupinetti FM, Warner J, Jones TK, Herndon SP (1997) Comparison of human tissues and mechanical prostheses for aortic valve replacement in children. Circulation 96:321–325

    CAS  PubMed  Google Scholar 

  16. Hasenkam JM, Kimose HH, Knudsen L, Gronnesby H, Halborg J, Christensen TD, Attermann J, Pilegaard HK (1997) Self management of oral anticoagulant therapy after heart valve replacement. Eur J Cardiothorac Surg 11:935–942

    Article  CAS  PubMed  Google Scholar 

  17. Raghuveer G, Caldarone CA, Hills CB, Atkins DL, Belmont JM, Moller JH (2003) Predictors of prosthesis survival, growth, and functional status following mechanical mitral valve replacement in children aged less than 5 years, a multi-institutional study. Circulation 108 (supp) II] :II174–179

    Article  PubMed  Google Scholar 

  18. Kabbani SS, Jamil H, Hammoud A, Hatab JA, Nabhani F, Hariri R, Sabbagh N, Ross D (2004) The mitral pulmonary autograft: assessment at midterm. Ann Thorac Surg 78:60–66

    Article  PubMed  Google Scholar 

  19. Elkins RC, Knott-Craig CJ, Ward EW, Lane MM (1998) The Ross operation in Children: 10-year experience. Ann Thorac Surg 65:496–502

    Article  CAS  PubMed  Google Scholar 

  20. Cleveland DC, Williams WG, Razzouk AJ, Trusler AT, Rebeyka IM, Duffy L, Kan Z, Coles JG, Freedom RM (1992) Failure of cryopreserved homograft valved conduits in the pulmonary circulation. Circulation 86 (suppl II):150–153

    Google Scholar 

  21. Stark J, Bull C, Stajevic M, Jothi M, Elliot M, de Leval M (1998) Fate of subpulmonary homograft conduits: determinants of late homograft failure. J Thorac Cardiovasc Surg 115:506–516

    Article  CAS  PubMed  Google Scholar 

  22. Forbess JM, Ashish SS, St. Louis JD, Jaggers JJ, Ungerleider RM (2001) Cryopreserved homografts in the pulmonary position: determinants of durability. Ann Thorac Surg 71:54–60

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiac Surgery, University Hospital Großhadern, Marchioninistr. 15, 81377, Munich, Germany

    Andreas R. Tiete MD, Joerg S. Sachweh, Jan Groetzner, Bruno J. Messmer & Sabine H. Daebritz

  2. Department of Pediatric Cardiology, University Hospital Aachen, Pauwelsstr., 52057, Aachen, Germany

    Eberhard G. Muehler

Authors
  1. Andreas R. Tiete MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joerg S. Sachweh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jan Groetzner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Gulbins
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eberhard G. Muehler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bruno J. Messmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sabine H. Daebritz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas R. Tiete MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tiete, A.R., Sachweh, J.S., Groetzner, J. et al. Systemic mechanical heart valve replacement in children under 16 years of age. Clin Res Cardiol 95, 281–288 (2006). https://doi.org/10.1007/s00392-006-0376-9

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-006-0376-9

Key words

Search

Navigation