Late results after left-sided cardiac valve replacement in children

Selection of types of cardiac valve substitutes for children remains controversial. Between 1976 and 1984, 166 children, 15 years of age or younger, underwent aortic (N = 53) or mitral valve replacement (N = 90) or both (N = 23). Biological prostheses were used in 84 patients and mechanical prostheses in 71; both a mitral bioprosthesis and an aortic mechanical valve were used in 11 patients. The overall early mortality was 9\%. Mean follow-up intervals were 4.1 years for the bioprosthesis group, 3.3 years for the mechanical valve group, and 3.5 years for the group receiving both. The 7 year survival rates (+/- standard error) were 63\% +/- 6\% in the bioprosthesis group and 70\% +/- 7\% in the mechanical valve group (p = NS). After aortic valve replacement the 7 year survival rates were 66\% +/- 14\% (bioprosthesis group) and 77\% +/- 9\% (mechanical valve group) (p = NS); after mitral valve replacement the rates were 65\% +/- 7\% (bioprosthesis group) and 54\% +/- 17\% (mechanical valve group) (p = NS). The incidence of thromboembolic events was 0.6\% +/- 0.4\% per patient-year in the bioprosthesis group (none after aortic valve replacement, 0.8\% +/- 0.6\% per patient-year after mitral valve replacement) and 1.4\% +/- 0.8\% per patient-year in the mechanical valve group (0.7\% +/- 0.7\% per patient-year after aortic valve replacement, 4.0\% +/- 2.8\% per patient-year after mitral valve replacement) (p = NS). The linearized rates of reoperation were 10.4\% +/- 1.8\% per patient-year (bioprosthesis group) and 2.3\% +/- 1.0\% per patient-year (mechanical valve group) (p less than 0.001). The 7 year probability rates of freedom from all valve-related complications were 43\% +/- 6\% in the bioprosthesis group and 86\% +/- 4\% in the mechanical valve group (p less than 0.001). In the aortic position, a mechanical adult-sized prosthesis can always be implanted, and satisfactory long-term results can be anticipated. In the systemic atrioventricular position, the results are less than satisfactory with either type of prosthesis; every effort should be made to preserve the natural valve of the child.