Aortic and mitral valve replacement in children: is there any role for biologic and bioprosthetic substitutes?☆

Abstract

While valve reoperation is inevitable following AVR and MVR with biologic and bioprosthetic substitutes; favorable results such as low valve-related morbidity rate, good long-term survival and functional status encourage their consideration as valid replacement alternatives in selected children especially females. Valve durability is higher in the mitral position and longevity of bioprosthetic valves is greater than that of homografts especially in the mitral position.

Age-Related Outcomes of the Ross Procedure Over 20 Years

“…Saleeb and colleagues [7] reported an 18% freedom from valve failure at 3 years with Mitroflow valves (Sorin Group, Milan, Italy) in patients aged younger than 30 years. Other studies have shown a very low 10-year freedom from valve failure with other bioprostheses as well as homografts in the younger patient population [8]. A study by Kulik and colleagues [9], in patients aged between 50 and 65 years, found that the freedom from the combined end point of reoperation, endocarditis, major bleeding, or thromboembolism after aortic valve replacement was 70.2% for mechanical and 41% for bioprosthetic valves at 10 years.…”

Accelerated Degeneration of a Bovine Pericardial Bioprosthetic Aortic Valve in Children and Young Adults

“…10,11 In the current era, however, newer bioprosthetic aortic valves, including pericardial valves, have had improved durability in older patients, shifting preference toward their use. [12][13][14] A strong desire of patients and families to avoid anticoagulation and associated complications or lifestyle modifications has furthered the interest in the use of bioprosthetic valves. Concerns about long-term neoaortic root dilation and the potential need for reoperation on both the neoaortic and the replaced pulmonary valve have reduced the attractiveness of the Ross procedure.…”

Reemplazo valvular mitral en edad pediátrica

“…Las ventajas de este tipo de válvula son: tener un buen perfil de flujo hemodinámi-co, menor potencial de obstrucción al tracto de salida del ventrículo izquierdo y mayor durabilidad. 3,8,[10][11][12] Como lo sugieren el Dr. Alsoufi y su grupo, los homoinjertos y válvulas biológicas, aunque no son la primera opción, son un recurso válido en pacientes de sexo femenino y en pacientes con pobre apego al tratamiento con anticoagulantes. Otro grupo de pacientes candidatos para colocación de una válvula biológica son los que no tienen acceso a una monitorización adecuada de la anticoagulación.…”

“…Otro grupo de pacientes candidatos para colocación de una válvula biológica son los que no tienen acceso a una monitorización adecuada de la anticoagulación. 7,9,12,13 En nuestra serie colocamos una válvula biológica en una paciente de 18 años con retraso moderado en el neurodesarrollo, de escasos recursos y con dificultad para llevar un adecuado control de anticoagulación.…”