title: Triple valve repair in children with rheumatic heart disease: long-term experience.
abstract: OBJECTIVE
  Triple valve replacement has poor early and long-term results, particularly in children, and few data are available on triple valve repair. Herein are reported the single-center, long-term results of combined aortic, mitral, and tricuspid valve repair in rheumatic children.
  
  
  METHODS
  Ten children (mean age 12 +/- 3 years) with severe rheumatic aortic, mitral, and tricuspid regurgitation underwent triple valve repair over a 17-year period, using a tailored cusp extension to repair the aortic valve, and ring annuloplasty and Carpentier's techniques to repair the mitral and tricuspid valves.
  
  
  RESULTS
  There were no early deaths. During a median follow up of 58 months (range: 3 months to 16 years), no late death occurred and four patients (40%) required reoperation at a median of three years (range: 2.7 to 12 years). Reoperations included one for mitral valve replacement, one for aortic valve replacement, and two for aortic and mitral valve replacements. Freedom from reoperation was 100% at one year, 63 +/- 17% at three, five, and 10 years, and 47 +/- 19% at 15 years.
  
  
  CONCLUSIONS
  In this particularly challenging patient group, triple valve repair provided satisfactory initial and mid-term results, with a high burden of reoperation in the long term, allowing a median of three years of growth and subsequent placement of a larger valve at the time of actual valve replacement. This strategy might be considered a good palliative surgical approach.
authors.affiliation: Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland. patrick.myers@hcuge.ch
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Myers
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cikirikcioglu
authors.forename: Cécile
authors.initials: C
authors.lastname: Tissot
authors.forename: Jan T
authors.initials: JT
authors.lastname: Christenson
authors.forename: Maurice
authors.initials: M
authors.lastname: Beghetti
authors.forename: Afksendiyos
authors.initials: A
authors.lastname: Kalangos
mesh_terms: D000293:Adolescent; D001021:Aortic Valve; D002648:Child; D002675:Child, Preschool; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008943:Mitral Valve; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000601:surgery*; D016896:Treatment Outcome; D014261:Tricuspid Valve