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Ann Thorac Surg 1999;68:521-525
© 1999 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, Department of Surgery, Seattle, Washington USA
b Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital and Regional Medical Center and the University of Washington, Seattle, Washington, USA
Address reprint requests to Dr Lupinetti, Children’s Hospital and Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105
e-mail: mlupin{at}chmc.org
Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan. 25–27, 1999.
Background. Aortic valve replacement (AVR) in children is now more commonly performed with human tissue valves.
Methods. The results of 100 consecutive pediatric AVRs (50 mechanical, 50 human) were reviewed.
Results. There were five perioperative deaths in the mechanical group and one in the human group (p = 0.2). Late complications in the mechanical group included 4 late deaths, 2 cases of endocarditis, 3 thromboembolic complications, and 10 reoperations on the aortic valve. In the human group, there were no late deaths, 2 reoperations for allograft aortic valve deterioration (both in Marfan’s patients), and 1 reoperation for allograft pulmonary valve stenosis. Four-year actuarial survival was 83% in the mechanical group and 98% in the human group (p = 0.02). Four-year actuarial survival free of all valve-related complications was 61% in the mechanical group and 88% in the human group (p = 0.008).
Conclusions. Human valves in children requiring AVR provide superior intermediate-term survival and freedom from valve-related complications compared to mechanical valves. Marfan’s syndrome may represent a rare remaining contraindication for human AVR in children.
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