Aortic valve replacement by mechanical prosthesis in children: A positive long-term outcome including for patients with an infantile Marfan syndrome - 25/12/18
pages | 2 |
Iconographies | 0 |
Vidéos | 0 |
Autres | 0 |
Résumé |
Background |
Aortic mechanical valve replacement (AVR) in children, is commonly associated with a high complication rate and a poor long-term prognosis, especially in children with infantile Marfan syndrome (IMS).
Methods |
We reviewed the clinical and surgical records of patients undergoing AVR at our institution between 2000 and 2017. Sixty-five children (49 boys and 16 girls) required 67 AVR at a median age of 12.5 years (range: 7 months to 17.9 years) and a median weight of 41.7kg (range: 7.5 to 110kg). Fourteen patients (21.5%) had a connective tissue disorder diagnosed in early childhood (IMS or Loeys–Dietz syndrome or osteogenesis imperfecta). Median follow-up for operative survivors was 4.6 years (IQR: 2.0–9.0 y, up to 16 y, 94% complete).
Results |
Global cardiac-related mortality was low 6% (n=4) and occurred mainly in the first post-operative days caused by acute bleeding. One-year, five-year and ten-year survival was respectively 94%, 91% and 91%. Among survivors, the 10-year freedom from reoperation was 82%. Complications after AVR included heart block requiring pacemaker implantation (5%), bleeding (4%), stroke (11%) and endocarditis (4%). There was no prosthesis thrombosis. All the patients with an IMS (n=12) had associated a moderate to severe aortic valve regurgitation and a significant aortic root dilatation. They required an ascending aorta replacement by composite graft concomitantly the AVR (Bentall procedure). Eight of these (73%) had previous aortic root replacement with a valve sparing technique (Yacoub or Tirone–David procedures). All patients with IMS survived. They remained free from aortic reoperation except one who required a larger aortic prosthesis 9 years later.
Conclusions |
Long-term results after AVR are excellent. Complications associated with surgery and long-term anticoagulation are rare. This study gives confidence in aortic mechanical prosthesis valve replacement including for children with an infantile MS.
Le texte complet de cet article est disponible en PDF.Plan
Vol 11 - N° 1
P. 137-138 - janvier 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’achat d’article à l’unité est indisponible à l’heure actuelle.
Déjà abonné à cette revue ?