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(Circulation. 2007;115:319-325.)
© 2007 American Heart Association, Inc.

Congenital Heart Disease

Early Outcomes of Tricuspid Valve Replacement in Young Children

Heather L. Bartlett, MD; Dianne L. Atkins, MD; Trudy L. Burns, MPH, PhD; Kelly J. Engelkes, BA; Sarah J. Powell, BA; Christine B. Hills, MD; James H. Moller, MD

From the Department of Pediatrics, Carver College of Medicine (H.L.B., D.L.A., T.L.B., K.J.E.), and Departments of Public Health Genetics and Epidemiology (T.L.B.), College of Public Health, University of Iowa, Iowa City; and Pediatric Cardiac Care Consortium (S.J.P., C.B.H., J.H.M.) and Department of Pediatrics (C.B.H., J.H.M.), University of Minnesota, Minneapolis.

Correspondence to Heather L. Bartlett, MD, Children’s Hospital of Iowa, Pediatric Cardiology, 200 Hawkins Dr, 2801 JPP, Iowa City, IA 52242. E-mail heather-bartlett{at}uiowa.edu

Received February 14, 2006; accepted November 3, 2006.

Background— Early outcomes after tricuspid valve replacement in young children are ill defined. The experience of the Pediatric Cardiac Care Consortium (45 centers, 1984 to 2002) was reviewed to evaluate the results of tricuspid valve replacement in children <6 years of age.

Methods and Results— Ninety-seven patients who underwent initial tricuspid valve replacement are included in the present analysis. The most frequent cardiac diagnoses were Ebstein’s anomaly (40%), pulmonary atresia (11%), and tetralogy of Fallot (8%). Age at tricuspid valve replacement was 2.9±1.7 years (mean±SD). Mean patient weight was 12.7±6.1 kg. The major outcome was survival to discharge. Associations among age, diagnosis, valve type/size, and outcome were evaluated through the use of ² analysis and logistic regression model fitting approaches. Hospital mortality was 26% and was very high (64%) in patients <1 year of age. A large size-to-weight ratio was the strongest predictor of mortality based on multivariable analysis (P<0.001). Mortality was 54% for patients with a size-to-weight ratio >2.5. Other complications included heart block requiring a pacemaker (13%) and thrombosis (5%). Pacemaker implantation was associated with the use of a mechanical valve (23% versus 6% bioprosthetic valve; P=0.01)

Conclusions— Tricuspid valve replacement in young children is associated with high mortality, especially in infants <1 year of age. Surgical options other than tricuspid valve replacement such as transplantation may need to be considered in infants.

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