The Journal of Thoracic and Cardiovascular Surgery, Vol 78, 123-127, Copyright © 1979 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Cardiac valve replacement in children: comparison of tissue with mechanical prostheses
RM Sade, JF Ballenger, AR Hohn, JE Arrants, DA Riopel and AB Taylor
Replacement of cardiac valves in children has been associated with high
rates of mortality and morbidity in the past. We have compared 24 children
from 2 to 18 years of age who have received mechanical valves with 24
children who have received porcine valves. The groups were similar except
that (1) there were more mitral operations in the mechanical valve group
and more aortic operations in the porcine valve group; (2) more porcine
than mechanical valves were implanted in recent years; and (3) the porcine
valve group comprised more young patients under 8 years and required more
complex operations. Early and late mortality rates were higher in the
mechanical than in the porcine valve group. Major late complications were
seen in 50 percent of the mechanical valve group and 13 percent of the
porcine group. Implantation of an adult-sized aortic valve was made
possible in all patients by the use of aortic augmentation annuloplasty.
Higher operative mortality rates in the mechanical valve group may have
been related more to technique of myocardial preservation during operation
than to type of valve. Although differing rates of late morbidity and
mortality may also have been related to myocardial preservation and other
technical factors, the type of valve used seemed to be an important
determinant of the better results in the porcine group. Despite unknown
durability of the porcine valve, our data suggest that the safest
prosthetic valve to use in children at this time is the
glutaraldehyde-fixed porcine prosthesis.
