Valve replacement in children less than 5 years of age

Abstract

Between 1966 and 1984, there were 63 children less than 5 years of age who underwent 70 valve replacements (49 mitral [5 repeat], 6 aortic, 11 tricuspid [systemic ventricle; 2 repeat]), 2 tricuspid [pulmonary ventricle] and 1 multiple [mitral-aortic]) at Children's Hospital. Tissue valves were used in 20%. Since 1980, only Björk-Shiley and St. Jude valves have been used. The most common indication for valve replacement was mitral regurgitation after repair of atrioventricular (AV) canal (34%). Mortality dropped considerably over time: 76% before 1979, 33% from 1979 to 1982 and 22% since 1982. More than two-thirds of fatalities were operative deaths, usually within 3 days of surgery. Actuarial survival curves for those operated on since 1980 predict 1 and 5 year survival of 73 and 51%, respectively. For the 46 operative survivors 1 and 5 year valve survival was 97 and 70%, respectively. Postoperative hemodynamics were significantly improved on elective postoperative catheterizations. All but one patient with non-tissue valves received anticoagulant therapy. Postoperative complications included thromboembolism (1.6/100 patients-years) and hemorrhage (0.8/100 patient-years). The frequency of intravascular hemolysis and endocarditis was 1.6%, comparable with adult experience. Complete heart block requiring a pacemaker developed in nine patients (14.1%), in all after AV valve replacement. Valve replacement in young children generally results in considerable hemodynamic improvement. The mortality rate remains above that observed in adults but has declined considerably for those operated on after 1980.

Antithrombotic Therapy in Neonates and Children

“…TE and bleeding events are uncommon with this therapy. [590][591][592][593][594] There is no direct evidence describing optimal thromboprophylaxis in children with bioprosthetic heart valves. Recommendations, therefore, must rely on indirect evidence from adults and the associated recommendations.…”

Self-Management of Oral Anticoagulant Therapy: A Review

“…Spevak et al [119] found that only 64% of the treated children maintained a PT within the desired range on at least 50% of the measurements. Streif et al [120] found, in a pediatric OAT clinic including a total of 319 children, that the percentage of INR measurements within target range depended on age and therapeutic INR target range; under the age of 1 year time within therapeutic INR target range was 37% ± 16 (mean ± 1 SD) rising up to 53% ± 19 for patients between 13 and 18 years.…”

Anticoagulation with Warfarin in Infants and Children

“…In a subset of 11 children within their larger sample who had regular checks of PT, Spevak et al 9 found that only 64% of those children maintained a PT within the desired range on at least 50% of the measurements. Another factor to consider is the patient's compliance with the monitoring regimen.…”