Early outcomes of tricuspid valve replacement in young children.
BACKGROUND
Early outcomes after tricuspid valve replacement in young children are ill defined. The experience of the Pediatric Cardiac Care Consortium (45 centers, 1984 to 2002) was reviewed to evaluate the results of tricuspid valve replacement in children <6 years of age.


RESULTS
Ninety-seven patients who underwent initial tricuspid valve replacement are included in the present analysis. The most frequent cardiac diagnoses were Ebstein's anomaly (40%), pulmonary atresia (11%), and tetralogy of Fallot (8%). Age at tricuspid valve replacement was 2.9+/-1.7 years (mean+/-SD). Mean patient weight was 12.7+/-6.1 kg. The major outcome was survival to discharge. Associations among age, diagnosis, valve type/size, and outcome were evaluated through the use of chi2 analysis and logistic regression model fitting approaches. Hospital mortality was 26% and was very high (64%) in patients <1 year of age. A large size-to-weight ratio was the strongest predictor of mortality based on multivariable analysis (P<0.001). Mortality was 54% for patients with a size-to-weight ratio >2.5. Other complications included heart block requiring a pacemaker (13%) and thrombosis (5%). Pacemaker implantation was associated with the use of a mechanical valve (23% versus 6% bioprosthetic valve; P=0.01)


CONCLUSIONS
Tricuspid valve replacement in young children is associated with high mortality, especially in infants <1 year of age. Surgical options other than tricuspid valve replacement such as transplantation may need to be considered in infants.
Bartlett
Heather L
HL
Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. heather-bartlett@uiowa.edu
Atkins
Dianne L
DL
Burns
Trudy L
TL
Engelkes
Kelly J
KJ
Powell
Sarah J
SJ
Hills
Christine B
CB
Moller
James H
JH
D001705:Bioprosthesis / Q000009:adverse effects; D001835:Body Weight / Q000502:physiology; D002675:Child, Preschool; D005260:Female; D006327:Heart Block / Q000209:etiology / Q000601:surgery; D006330:Heart Defects, Congenital / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D007223:Infant; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013927:Thrombosis / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*