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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 80-85, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
A el Makhlouf, B Friedli, I Oberhansli, JC Rouge and B Faidutti
We report the results and long-term follow up in 273 children (aged 2 to 16
years) who underwent prosthetic valve replacement. Mechanical valves
(mostly Starr-Edwards) were used in almost all, and in 62 children more
than one valve was replaced. Operative mortality was 4.7%. Actuarial
survival curves (including hospital mortality) indicate a 86% survival rate
at 5 years and 75% at 10 years. For isolated mitral valve prostheses (the
largest subgroup), the figures are 87% at 5 years and 82% at 10 and 15
years. The main complication was thromboembolism, which occurred at a
linearized rate of 2.7 per 100 patient-years. Actuarial curves indicate
that 88% of patients are embolus free at 5 years, and 77% at 10 years. No
patient with aortic valve replacement only had an embolism. Five of eight
tricuspid prostheses thrombosed. Patients given aspirin and dipyridamole
only did not have a higher rate of thromboembolic events than those given
warfarin. There were five cases of endocarditis (two fatal) and four of
dehiscence. No patient so far has needed replacement of a prosthesis
because of somatic growth. Thus valve replacement can be performed with low
mortality in children, and with satisfactory long-term survival.
Thromboembolism remains a significant problem, although it appears to be
less common than in adults. In this study, treatment with antiplatelet
drugs only did not carry a higher rate of thromboembolic events than did
treatment with warfarin.
ARTICLES
Prosthetic heart valve replacement in children. Results and follow-up of 273 patients
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