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(Circulation. 1997;96:321-325.)
© 1997 American Heart Association, Inc.

Articles

Comparison of Human Tissues and Mechanical Prostheses for Aortic Valve Replacement in Children

Flavian M. Lupinetti, MD; Joanie Warner, RN, MSN; Thomas K. Jones, MD; ; S. Paul Herndon, MD

From the Division of Cardiac Surgery, Department of Surgery, and the Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital and Medical Center and the University of Washington, Seattle, Wash.

Correspondence to Flavian M. Lupinetti, MD, Division of Cardiac Surgery, Children's Hospital and Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105. E-mail mlupin{at}chmc.org

Background Aortic valve replacement in children is problematic because of complications of mechanical valves and uncertain outcomes associated with human valves. The results of pediatric aortic valve replacements over 5 years were reviewed.

Methods and Results Mechanical valves were used exclusively during the first part of this series (n=26). Thereafter, 25 consecutive aortic valve replacements were performed with autografts (n=19) or allografts (n=6). Allografts were used for Marfan's syndrome patients or those with unusable pulmonary valves. Among autograft/allograft recipients, 16 patients underwent 27 prior operations. In the mechanical group, 18 patients underwent 19 previous operations. Three patients in each group underwent a previous mechanical aortic valve replacement. Operative complications included two mild strokes and one pacemaker in the autograft/allograft group and three deaths and two pacemakers in the mechanical group. One autograft recipient required reoperation for pulmonary allograft stenosis. In the mechanical group, late complications included six cases of nonstructural degeneration and two cases of endocarditis, with three reoperations. Reoperation-free survival was 96% at 2 years in the autograft/allograft group and 80% at 2 years and 75% at 3 years in the mechanical group. Event-free survival was 96% at 2 years in the autograft/allograft group compared with 67% at 2 years and 49% at 3 years in the mechanical group (P<.05).

Conclusions The frequency of reoperations for mechanical aortic valve replacement has been surprisingly high. Aortic valve replacement in children with only autografts or allografts achieves good early results.

Key Words: aortic valve • valve prosthesis • allograft

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