Valve replacement in children. A fifteen-year perspective.

Between 1965 and 1980, 64 children from 1 to 19 years of age have undergone replacement of the aortic, mitral, or tricuspid valve at The Johns Hopkins Hospital. Three of these patients have had successful second valve replacements 4 to 12 years after the initial operation. During the first 5 year period of this review, the hospital mortality was 31%, whereas only one of 33 children having valve replacement during the most recent 5 year period died early after operation (hospital mortality, 1976 to 1980, 3%). Thromboembolic complications have been seen in only two patients in this group, for an incidence of 0.8% per patient-year. Among patients receiving long-term warfarin anticoagulation, there has been only one major bleeding episode in 133 patient-years of follow-up. The type of valve prosthesis implanted during this 15 year period has changed greatly. Ninety-four percent of the prostheses placed during the initial 5 year period were the caged-poppet type of valve, whereas tilting disc, central flow, and tissue valve substitutes have been implanted more recently. Eight of the 10 patients most recently undergoing valve replacement have received St. Jude Medical prostheses, and postoperative catheterization studies have confirmed the excellent hemodynamic performance of these valves, even in patients with prostheses of very small annular diameter. Despite the disappointing occurrence of premature tissue valve failure in the young population, valve replacement in children currently is safer and there is a wider variety of technically satisfactory valve substitutes available for implantation today.