St. Jude Medical® Cardiac Valve Experience in Infants and Children

During the last 7 years, 44 ST. JUDE MEDICAL® cardiac valves have been placed in 43 children. Nine patients were less than 1 year of age and 1 child had a double valve replacement. Twenty-four valves were placed in the aortic position. Seven of these patients underwent valve replacement only, while 16 patients had concomitant aortoventriculoplasties, and 1 patient had a Manouguian procedure. There were 2 early and no late deaths. Both deaths occurred in critically ill children who underwent emergency operations. Twenty valves were placed in the mitral position (12 annular and 8 supra-annular). There were no deaths with annular replacements and 7 deaths (2 early and 5 late) when supra-annular placement was used. Four of the 5 late deaths had marked preoperative left ventricular dysfunction. Mean patient follow-up is 43 months in 34 long-term survivors. Anticoagulation was achieved with warfarin, often in combination with sulfinpyrazone or dipyridamole. There have been 3 episodes of thromboembolism, all occurring in patients with suboptimal anticoagulation. We conclude that: 1) results from ST. JUDE MEDICAL cardiac valve replacement in the aortic position or in the mitral position with annular placement in children are excellent, 2) anticoagulation with warfarin is warranted, and 3) morbidity and mortality are often related to the underlying disease (mitral annular hypoplasia or left ventricular dysfunction) rather than to valve malfunction or technical problems at operation.