Intermediate-term results in pediatric aortic valve replacement.
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.
Lupinetti
F M
FM
Department of Surgery, Children's Hospital and Regional Medical Center and the University of Washington, Seattle 98105, USA. mlupin@chmc.org
Duncan
B W
BW
Scifres
A M
AM
Fearneyhough
C T
CT
Kilian
K
K
Rosenthal
G L
GL
Cecchin
F
F
Jones
T K
TK
Herndon
S P
SP
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery* / Q000637:transplantation; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation; D015996:Survival Rate; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous