title: Accelerated degeneration of a bovine pericardial bioprosthetic aortic valve in children and young adults.
abstract: BACKGROUND
  Experience with aortic valve replacement (AVR) with current-generation pericardial bioprostheses in young patients is limited. The death of a child with accelerated bioprosthetic aortic stenosis prompted enhanced surveillance of all such patients at our institution.
  
  
  RESULTS
  We reviewed records of 27 patients who had undergone AVR (median follow-up, 13.7 months) with a bovine pericardial bioprosthesis at ≤30 years of age. In the Mitroflow LXA valve group (n=15), freedom from valve failure was 100% at 1 year, 53% (95% confidence interval, 12-82) at 2 years, and 18% (95% confidence interval, 1-53) at 3 years. No Magna/Magna Ease valves (n=12) failed by 3 years. Among valve failure patients, median age at AVR was 12 years (range, 10-21 years). Life-threatening prosthetic aortic stenosis was detected at a median of 6 months after prior echocardiograms showing mild or less gradients. Patients with Mitroflow LXA compared with Magna/Magna Ease valves were smaller (median body surface area, 1.42 versus 1.93 m(2); P=0.002) and younger (median age, 13.0 versus 20.9 years; P=0.02) at AVR. Pathology demonstrated diffuse intrinsic leaflet calcification, not associated with inflammation or infection, and virtually immobile leaflets in closed position.
  
  
  CONCLUSIONS
  Young patients undergoing AVR with Mitroflow LXA pericardial valves are at high risk for rapid progression from mild or less to severe aortic stenosis over months, highlighting their need for heightened echocardiographic surveillance and suggesting that this aortic bioprosthesis should not be implanted in the young. Current data are insufficient to assess the safety of AVR with other pericardial bioprostheses in children and the youngest adults.
authors.affiliation: From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children's Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women's Hospital, Boston, MA (R.F.P).
authors.forename: Susan F
authors.initials: SF
authors.lastname: Saleeb
authors.affiliation: From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children's Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women's Hospital, Boston, MA (R.F.P). jane.newburger@cardio.chboston.org.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.affiliation: From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children's Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women's Hospital, Boston, MA (R.F.P).
authors.forename: Tal
authors.initials: T
authors.lastname: Geva
authors.affiliation: From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children's Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women's Hospital, Boston, MA (R.F.P).
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Baird
authors.affiliation: From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children's Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women's Hospital, Boston, MA (R.F.P).
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.affiliation: From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children's Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women's Hospital, Boston, MA (R.F.P).
authors.forename: Robert F
authors.initials: RF
authors.lastname: Padera
authors.affiliation: From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children's Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women's Hospital, Boston, MA (R.F.P).
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Del Nido
authors.affiliation: From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children's Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women's Hospital, Boston, MA (R.F.P).
authors.forename: Michele J
authors.initials: MJ
authors.lastname: Borisuk
authors.affiliation: From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children's Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women's Hospital, Boston, MA (R.F.P).
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Sanders
authors.affiliation: From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children's Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women's Hospital, Boston, MA (R.F.P).
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001705:Bioprosthesis; D002114:Calcinosis / Q000209:etiology*; D002417:Cattle; D002648:Child; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D008297:Male; D010496:Pericardium / Q000473:pathology* / Q000637:transplantation; D011183:Postoperative Complications / Q000209:etiology*; D011475:Prosthesis Failure; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D014463:Ultrasonography; D055815:Young Adult
keywords: heart defects, congenital; prosthesis implantation; valves