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Ann Thorac Surg 1987;43:285-287
© 1987 The Society of Thoracic Surgeons

Articles

Thromboembolic and Other Events Following Valve Replacement in a Pediatric Population Treated with Antiplatelet Agents

Lynn B. McGrath, M.D.*, Lorenzo Gonzalez-Lavin, M.D., W. Jay Eldredge, M.D., Maria Colombi, M.D., Dario Restrepo, M.D.

From the Departments of Surgery and Pediatrics, Deborah Heart and Lung Center, Browns Mills, NJ, and the Department of Surgery, University of Medicine and Dentistry of New Jersey, Rutgers Medical School, East Rutherford, NJ

Accepted for publication May 7, 1986.

* Address reprint requests to Dr. McGrath, Department of Surgery, Deborah Heart and Lung Center, Browns Mills, NJ 08015

To determine if anticoagulation therapy is necessary after valve replacement with the St. Jude Medical prosthesis in young subjects, 30 consecutive patients were studied. They ranged in age from 4 to 20 years, and each had undergone valve replacement some time between February, 1982, and June, 1984. There was 1 hospital death (3.3%; 70% confidence limits [CL] = 0.4% to 10.9%). The 29 hospital survivors were treated with aspirin and dipyridamole. All patients were followed up. There were 5 late deaths (17.2%; 70% CL = 9% to 27%), at a mean of 8 months postoperatively. Follow-up revealed that 7 thromboembolic events occurred in 7 of the hospital survivors (24.1%; 70% CL = 15% to 35%). Hemiparesis occurred in 1 patient, and documented valve thrombosis and death occurred in another. Transient sensorimotor deficits were found in the 5 other patients. Prosthetic valve endocarditis developed in 1 hospital survivor (3.5%; 70% CL = 0.4% to 11%) and resulted in late death. There were no reoperations in the hospital survivors. We conclude that the St. Jude Medical prosthesis is useful for valve replacement in the young because of its low profile, durability, and hemodynamic characteristics. However, we recommend that these patients receive full anticoagulation therapy.




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