Intermediate-term results after the aortic valve replacement using bileaflet mechanical prosthetic valve in children

Abstract

Although aortic annular enlargement was required in more than half of the cases, intermediate-term results after aortic valve replacement using bileaflet mechanical prosthetic valve in children was satisfactory. Indications for alternative treatment such as Ross procedure might be considered in limited cases.

Congenital Aortic Stenosis in Childhood

“…Freedom from surgical re-intervention ranges between 80-92% at 10 years (Alexiou et al, 2000;Champsaur et al, 1997;Mazzitelli et al, 1998;Turrentine et al, 2001), 85-86% at 15 years (Alexiou et al, 2000;Turrentine et al, 2001) and 54-86% at 20 years (Alexiou et al, 2000;Mazzitelli et al, 1998). A very recent series from Japan of 45 children with a median follow-up of 9.2 years showed excellent outcomes, with an actuarial freedom from reoperation of 94% at 15 years (Masuda et al, 2008). This publication also noted that 40 of the 42 (95%) survivors had a peak Doppler gradient less than 3 m/s at the latest evaluation.…”

“…This finding endorses the previous report of 44 of the 50 (88%) survivors being in NYHA class I with a mean Doppler gradient across the aortic prosthesis of 17.9 mmHg at last follow-up (mean follow-up of 7.7 years) (Alexiou et al, 2000), thus highlighting the importance of the functional status and the hemodynamic performance. Some authors have observed a correlation among transprosthetic flow velocity and manufactured valve area, suggesting that implantation of mechanical valves of 19 mm or larger may not require further re-replacement (Masuda et al, 2008;Shanmugan et al, 2005). This is obviously a clear limitation for the low spectrum of the pediatric age group.…”

“…Operative death rate varies between 0-5% in several series (Alexiou et al, 2000;Karamlou et al, 2005;Masuda et al, 2008;Mazzitelli et al, 1998;Popov et al, 2009;Turrentine et al, 2001), mostly involving children with severe preoperative pulmonary hypertension or myocardial dysfunction. Although previous series showed worse outcomes, more recent studies report actuarial survival of 89-95% at 10 years (Alexiou et al, 2000;Turrentine et al, 2001), 87-92% at 15 years (Masuda et al, 2008) and 85% at 20 years (Alexiou et al, 2000). Freedom from surgical re-intervention ranges between 80-92% at 10 years (Alexiou et al, 2000;Champsaur et al, 1997;Mazzitelli et al, 1998;Turrentine et al, 2001), 85-86% at 15 years (Alexiou et al, 2000;Turrentine et al, 2001) and 54-86% at 20 years (Alexiou et al, 2000;Mazzitelli et al, 1998).…”

“…This enlargement can be performed by different techniques: the Konno procedure involves incision of the ventricular septum, which might cause ventricular dysfunction, atrioventricular conduction block or arrhythmias; the Manouguian procedure with extension of the incision to the anterior mitral leaflet might cause mitral inssufficiency; and Yamaguchi procedure with an anterior incision in the aortic annulus is directed into the commissure between the right and left coronary cusps continued downward across the aortic ring to near full thickness of the right ventricular wall, is nowadays the technique of choice because it does not damage the ventricular septum or the mitral valve (Masuda et al, 2008). Operative death rate varies between 0-5% in several series (Alexiou et al, 2000;Karamlou et al, 2005;Masuda et al, 2008;Mazzitelli et al, 1998;Popov et al, 2009;Turrentine et al, 2001), mostly involving children with severe preoperative pulmonary hypertension or myocardial dysfunction. Although previous series showed worse outcomes, more recent studies report actuarial survival of 89-95% at 10 years (Alexiou et al, 2000;Turrentine et al, 2001), 87-92% at 15 years (Masuda et al, 2008) and 85% at 20 years (Alexiou et al, 2000).…”

Prosthetic valves in adult patients with congenital heart disease: Rationale and design of the Dutch PROSTAVA study

“…The prevalence of PPM is probably high in adult patients with CHD, both with biological and with mechanical valves, because of somatic growth of patients after implantation of a small valve during childhood. A few small series have investigated mid-and long-term complications of prosthetic valves including PPM in children [5,6]. However, the prevalence of PPM and its consequences in adult patients with CHD are unknown.…”