title: Outcome of left heart mechanical valve replacement in West African children--a 15-year retrospective study.
abstract: BACKGROUND
  The West African sub-region has poor health infrastructure. Mechanical valve replacement in children from such regions raises important postoperative concerns; among these, valve-related morbidity and complications of lifelong anticoagulation are foremost. Little is known about the long-term outcome of mechanical valve replacement in West Africa. We sought to determine the outcome of mechanical valve replacement of the left heart in children from this sub-region.
  
  
  METHODS
  We conducted a retrospective review of all consecutive left heart valve replacements in children (< 18 years old) from January 1993 - December 2008. The study end-points were mortality, valve-related morbidity, and reoperation.
  
  
  RESULTS
  One hundred and fourteen patients underwent mitral valve replacement (MVR), aortic valve replacement (AVR) or mitral and aortic valve replacements (MAVR). Their ages ranged from 6-18 years (13.3 ± 3.1 years). All patients were in NYHA class III or IV. Median follow up was 9.1 years. MVR was performed in 91 (79.8%) patients, AVR in 13 (11.4%) and MAVR in 10 (8.8%) patients. Tricuspid valve repair was performed concomitantly in 45 (39.5%) patients. There were 6 (5.3%) early deaths and 6 (5.3%) late deaths. Preoperative left ventricular dysfunction (ejection fraction < 45%) was the most important factor contributing to both early and late mortality. Actuarial survival at 1 and 15 years were 98.1% and 94.0% respectively. Prosthetic valve thrombosis occurred in 5 patients at 0.56% per patient-year. There was 1(0.9%) each of major bleeding event and prosthetic valve endocarditis. Two reoperations were performed at 0.22% per patient-year. Actuarial freedom from reoperation was 99.1% at 1 and 10 years, and 85.1% at 15 years.
  
  
  CONCLUSIONS
  Mechanical valve replacement in West African children has excellent outcomes in terms of mortality, valve-related events, and reoperation rate. Preoperative left ventricular dysfunction is the primary determinant of mortality within the first 2 years of valve replacement. The risk of valve-related complications is acceptably low. Anticoagulation is well tolerated with a very low risk of bleeding even in this socioeconomic setting.
authors.affiliation: National Cardiothoracic Center, Korle Bu Teaching Hospital, P.O. Box KB 846, Accra, Ghana. fedwin68@yahoo.com
authors.forename: Frank
authors.initials: F
authors.lastname: Edwin
authors.forename: Ernest
authors.initials: E
authors.lastname: Aniteye
authors.forename: Mark Mawutor
authors.initials: MM
authors.lastname: Tettey
authors.forename: Martin
authors.initials: M
authors.lastname: Tamatey
authors.forename: Kwabena
authors.initials: K
authors.lastname: Frimpong-Boateng
mesh_terms: D000293:Adolescent; D001021:Aortic Valve / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005869:Ghana / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D009017:Morbidity / Q000639:trends; D011474:Prosthesis Design; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome