PMID- 10731647
OWN - NLM
STAT- MEDLINE
DCOM- 20000519
LR  - 20190513
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 17
IP  - 2
DP  - 2000 Feb
TI  - Aortic valve replacement in children: are mechanical prostheses a good option?
PG  - 125-33
AB  - OBJECTIVE: The choice of the most appropriate substitute in children with 
      irreparable aortic valve lesions remains controversial. The aim of this study was 
      to assess early and late outcomes following aortic valve replacement (AVR) with 
      mechanical prostheses in children. PATIENTS: Fifty-six patients (42 male, 14 
      female, mean age 11.2, range 1-16 years) undergoing AVR with mechanical 
      prostheses between October 1972 and January 1999 were evaluated. Thirty-six 
      patients (64.2%) underwent previous cardiac surgery. Disease aetiology was 
      congenital in 47 patients (congenital aortic stenosis in 33, and other congenital 
      abnormalities in 14) (83.9%), infective in four (7. 1%), rheumatic in two (3.4%), 
      and three (5.3%) had connective tissue disorders. Haemodynamic indication for AVR 
      was aortic regurgitation (AR) in 24 (42.8%), aortic stenosis (AS) in 22 (39.2%) 
      and mixed disease in ten (17.8%). Twenty-eight patients (50.0%) were in New York 
      Heart Association (NYHA) class III-IV before surgery. Concomitant procedures were 
      performed in 31 patients (55.3%), including aortic root enlargement in 28 (50%). 
      The mean size of implanted valves was 22.4 mm (range 17-27 mm). All patients 
      received long-term anticoagulation treatment with sodium warfarin, aiming to 
      maintain an international normalized ratio (INR) between 2.5-3.0. The mean 
      follow-up was 7.3 years (range 0-26, total 405 patient-years). RESULTS: Operative 
      mortality was 5.3% (three patients). Three patients developed complete heart 
      block requiring pacing, two of them permanently. Late events included valve 
      thrombosis (one), transient stroke (one), paravalvular leak of a mitral 
      prosthesis (one), aneurysm of sinus of Valsalva (one) and pannus ingrowth (one). 
      There was no major haemorrhagic event. Five patients required re-operation 
      (8.9%), but none due to outgrowth of the valve. Regarding actuarial freedom from 
      thrombo-embolism, any valve-related event and re-operation at 20 years was 93, 
      86.6 and 86. 4%. There were three late deaths. Actuarial survival, including 
      operative mortality, at 10 and 20 years was 91 and 84.9%. The actuarial survival 
      for the group of the patients with congenital AS (n=33) at 10 and 20 years was 
      93.5%, whereas for the children with other congenital heart problems (n=14) this 
      was 85.7 and 64.3% (P=0. 09). At the latest clinical evaluation, 44 children were 
      in NYHA class I and six were in class II. The mean gradient across the aortic 
      prosthetic valve on echocardiography was 17.9 mmHg (range 0-47 mmHg). 
      CONCLUSIONS: Mechanical AVR, with enlargement of the aortic root if necessary, 
      remains an excellent treatment option in children. It is associated with 
      acceptable operative mortality, low incidence of late events and re-operation, 
      and provides good long-term survival. It clearly represents a good alternative to 
      available biological substitutes, including the pulmonary autograft (Ross 
      procedure).
FAU - Alexiou, C
AU  - Alexiou C
AD  - Department of Cardiac Surgery, The General Hospital, Tremona Road, Southampton, 
      UK.
FAU - McDonald, A
AU  - McDonald A
FAU - Langley, S M
AU  - Langley SM
FAU - Dalrymple-Hay, M J
AU  - Dalrymple-Hay MJ
FAU - Haw, M P
AU  - Haw MP
FAU - Monro, J L
AU  - Monro JL
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
RN  - 0 (Anticoagulants)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
MH  - Actuarial Analysis
MH  - Anticoagulants/therapeutic use
MH  - Aortic Valve
MH  - Aortic Valve Insufficiency/mortality/*surgery
MH  - Aortic Valve Stenosis/congenital/mortality/*surgery
MH  - Child
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Defects, Congenital/mortality/surgery
MH  - Heart Valve Prosthesis
MH  - *Heart Valve Prosthesis Implantation
MH  - Humans
MH  - Male
MH  - Prosthesis Design
MH  - Warfarin/therapeutic use
EDAT- 2000/03/25 09:00
MHDA- 2000/06/08 09:00
CRDT- 2000/03/25 09:00
PHST- 2000/03/25 09:00 [pubmed]
PHST- 2000/06/08 09:00 [medline]
PHST- 2000/03/25 09:00 [entrez]
AID - S1010-7940(00)00324-9 [pii]
AID - 10.1016/s1010-7940(00)00324-9 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2000 Feb;17(2):125-33. doi: 
      10.1016/s1010-7940(00)00324-9.