Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart disease

Patrick O Myers; Suyog A Mokashi; Edward Horgan; Michele Borisuk; John E Mayer Jr; Pedro J Del Nido; Christopher W Baird

doi:10.1016/j.jtcvs.2018.08.077

Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart disease

J Thorac Cardiovasc Surg. 2019 Jan;157(1):329-340. doi: 10.1016/j.jtcvs.2018.08.077. Epub 2018 Sep 21.

Authors

Patrick O Myers¹, Suyog A Mokashi², Edward Horgan², Michele Borisuk², John E Mayer Jr², Pedro J Del Nido², Christopher W Baird³

Affiliations

¹ Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass; Division of Cardiovascular Surgery, Geneva University Medical School, Geneva, Switzerland.
² Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
³ Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass. Electronic address: bairdc1@gmail.com.

PMID: 30557950
DOI: 10.1016/j.jtcvs.2018.08.077

Abstract

Objectives: There are little recent data on the outcomes of mechanical aortic valve replacement (AVR) in children and young adults with congenital aortic valve disease. We sought to review the survival and associated thromboembolic or bleeding complications after mechanical AVR at a single center.

Methods: Data were retrospectively collected for 121 patients undergoing prosthetic AVR from 2000 to 2014. Kaplan-Meier estimates and Cox proportional hazards were employed.

Results: Median age at AVR was 16 years (interquartile range, 12-22.8 years). The valves implanted were the St Jude valve (St Jude Medical Inc, St Paul, Minn) in 79 patients (62%), the On-X valve (On-X Life Technologies Inc, Austin, Tex) in 45 patients (35%), and CarboMedics (Sorin SpA, Milan, Italy) in 3 patients (2.4%). Median valve size was 23 mm (range, 21-25 mm). There were 5 early deaths (3.9%). Median follow-up was 5 years (range, 1.6-9.2 years; 600 patient-years). There were 14 deaths during follow-up. Survival was 90.6% ± 2.8% at 1 year, 85.4% ± 3.7% at 5 years, and 81.5% ± 4.5% at 10 years. Freedom from aortic valve reoperation was 98% ± 1.4% at 1 and 5 years, 91.5% ± 3.9% at 7 years, and 78.4% ± 6.9% at 10 years and at latest follow-up. Univariable analysis identified younger age, lower weight, and use of a 16-mm CarboMedics valve as predictors of reoperation. Valve sizes of 16 or 17 mm have a significantly higher risk of reoperation compared with larger valves (log-rank test, P < .001). At multivariable analysis, only younger age was a significant independent predictor of reoperation (hazard ratio, 0.84; 95% confidence interval, 0.71-0.99; P = .038). All patients were treated with warfarin to a goal international normalized ratio of 2.0 to 3.0. Four patients (3.1%; 0.66% per patient-year) had thromboembolic complications, and 5 patients (3.9%; 0.83% per patient-year) had bleeding events during follow-up.

Conclusions: Mechanical AVR in patients with congenital heart disease has excellent short- and midterm outcomes. Younger age was an independent predictor of reoperation.

Keywords: aortic valve; aortic valve replacement; mechanical valve; pediatric cardiac surgery.

MeSH terms

Adolescent
Adult
Aortic Valve / abnormalities
Aortic Valve / surgery*
Aortic Valve Stenosis / congenital
Aortic Valve Stenosis / surgery
Child
Female
Heart Valve Prosthesis Implantation* / adverse effects
Heart Valve Prosthesis Implantation* / methods
Heart Valve Prosthesis Implantation* / mortality
Heart Valve Prosthesis*
Humans
Male
Reoperation
Retrospective Studies
Survival Analysis
Treatment Outcome
Young Adult