Mechanical Valves in Children

[Guest]

Medium-term follow-up of mechanical valves inserted in children.

Larsen SH, Houlind K, Hansen OK, Hjortholm K, Emmertsen K, Hjortdal V.
Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark.

Cardiol Young. 2006 Dec;16(6):579-85.

Objective: We reviewed our experience with mechanical valves inserted between 1988 and 2002 in children aged 15 years or younger. Methods: Hospital files were extracted retrospectively. Follow-up was completed by March 2005. Results: Of 41 patients, we inserted a valve in atrioventricular position in 27 children, having a median age of 3.1 years, ranging from 0.4 to 14.5 years, and in aortic position in the remaining 14, having a median age of 13.5 years, and a range from 7.0 to 14.9 years. For the valves inserted in atrioventricular position, the underlying disease was congenital in 23, rheumatic in two, post-endocarditic in one, and Marfan's syndrome in one. Mean follow-up was 7.7 years, with standard deviation of 5.3, giving a total follow-up of 209 patient years. Mortality at 30 days was 7%, and survival was 73% at up to 16 years follow-up. Events related to anticoagulation were seen in 3 patients, corresponding to 1.4% per patient year. In 6 patients (22%), heart block ensued which required implantation of a pacemaker treatment, and 5 patients (19%) had reoperations. For the implantations in aortic position, the underlying disease was congenital in 13, stenosis in 10 and insufficiency in three, and post-endocarditis in one. Mean follow-up was 6.8 years, with standard deviation of 4.6, giving a total of 95 patient years. We lost one patient within 30 days (7.7% mortality), and survival was 77% at up to 13 years follow-up. There were no incidents of thrombosis, nor events related to anticoagulation, but one patient (7%) needed insertion of a pacemaker due to a perioperative heart block, and one (7%) required new valvar replacement. Conclusions: Although preferably avoided, mechanical valves can be implanted in children with an acceptable mortality and morbidity, and good long-term results.

 

[gijanet]

Thanks, Al, for posting this!

Thanks, Al, for posting this!

I haven't seen many studies on prosthetic valves in kids.......... well, none, now that I really think about it.

I'm not sure I totally agree with the "acceptable mortality and morbidity" part, though. If your kid was among the 27% that didn't survive, I don't think that would be very "acceptable." Katie falls in the first atrioventricular valve grouping, by the way. I realize this was a fairly small sampling, but doubt there is a study on a larger group as our kids are still a fairly rare breed - especially the common AV ones. I found it interesting, too, that the median age was so much younger in the common AV group - 3.1 as opposed to 13 for the other. Katie was four and 1/2 when she got hers. I wonder, too, why the aortic valve group was so small since that is more common. I'm thinking because the Ross would normally be performed if that was a good option. Babbling out loud.............

Thanks so much for sharing. Through God's will, home testing, and guys like you, Al, we will hopefully stay in that 73% survival group. We are about to hit our 1&1/2 year valve anniversary Jan. 12th.

Much love. J.

 

[Emma]

Thanks for that Al. I've not seen any studies on it before either - not ones worth looking at!
Have to agree with Janet on their 'acceptable mortality' comment - surely thats not the best phrase they could've used there.
But interesting to read, so thankyou
Love Emma
xxx

 

[Guest]

I'm glad I didn't write the article, only copied it.

 

[DrAllan]

As a physician I cannot help but comment on the phrase ?acceptable mortality?. This is a high-risk surgical group that without treatment has 100% mortality over a relatively short period of time. Replacement of the same valve position in adults for other indication usually results in a mortality rate of 1%-3%. So for kids their risk is at least doubled. However, compare to no treatment at all, then the risk is ?acceptable?.

 

[gijanet]

I'm glad I didn't write the article, only copied it.

But we are so glad you did. Please post anything else you come across so I can pick it apart, too................. heehee! Hugs. J.

 

[gijanet]

Hmmmm...

Hmmmm...

Replacement of the same valve position in adults for other indication usually results in a mortality rate of 1%-3%. So for kids their risk is at least doubled.

Must be that "new" math. 27% is a wee bit more than 1-3% doubled when using the old math.

I do know what you are saying, though. I realize this article was written for physicians and surgeons, not parents. As the parent of a child with a very complex anatomy and one who has handed her over to the surgeons far too many times the last six years, I am all too well aware that Katie is a high risk patient. (That is why we have sought out numerous surgical opinions from all over the country. We chose Dr. Bove at the University of Michigan - yes, some 1500 miles from here, and he has performed Katie's last four surgeries.) Again, I know all too well that we had very limited options and that something had to be done. And let's face it, when it gets right down to it, if your choice is between death and doing "something" to try and prevent that, then you are going to choose doing "something," regardless of the statistics. Still, from a parent's viewpoint, a 27% mortality rate deemed as "acceptable" is painful to read and difficult to stomach. Guess it just depends on what side of the scalpel you are.................

Al, keep 'em coming. Hugs. J.

 

[DrAllan]

dear Gigi:

The qoute was "We lost one patient within 30 days (7.7% mortality), and survival was 77% at up to 13 years follow-up.". The figures in the article and the literature refer to post-operative mortality. Nowhere is a survival curve mentioned for the next 5 years. This is a minor point but crucial to both doctor and patient making an informed decision. True the definition of post-operative pweriod is not well defined. Everyone will accept 30 days, the most crucial period, but some studies can extend this to as much as 3-66 months. By one year, death is resonably attributed to the underlying illness rather than any surgical intervention.

Best to you

 

[catwoman]

By one year, death is resonably attributed to the underlying illness rather than any surgical intervention.

I've always assumed that long-range mortality stats refer to a myriad of causes. Would non-cardiac-related causes (cancer & other diseases, auto/home accidents, suicide, homicide, etc.) be included too?

 

[Emma]

But we are so glad you did. Please post anything else you come across so I can pick it apart, too................. heehee! Hugs. J.

I agree

xxx

 

[Emma]

Still, from a parent's viewpoint, a 27% mortality rate deemed as "acceptable" is painful to read and difficult to stomach. Guess it just depends on what side of the scalpel you are.................

Al, keep 'em coming. Hugs. J.

And double agree!
xxx

 

[KeegansMom02]

It's nice to see...

It's nice to see...

A publication about vr patients. It's not something ya see on a daily basis. Too bad there's no study on Mitral valves though.

Thanks Al!