Outcome of Mechanical Heart Valve Replacement in Children

  • Dr Frank Edwin, National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
  • Dr Lawrence Sereboe, National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
  • Dr Mark Tettey, National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
  • Dr Ernest Aniteye, National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
  • Dr David Kotei, National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
  • Dr Martin Tamatey, National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
  • Dr Kow Entsua-Mensah, National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana
  • Prof Kwabena Frimpong-Boateng, National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana

    • Objective
    Cost constraints and the need to avoid reoperation make valve replacement an attractive option for a durable valve substitute in developing nations. This study was carried out to evaluate the outcome of mechanical valve replacement of the left heart in children (≤18years) at Ghana’s National Cardiothoracic Centre.
    Method
    A retrospective analysis of all consecutive left heart valve replacements performed from January 1993-November 2008 was carried out. The study end-points included mortality, valve-related morbidity, and re-operation.
    Results
    In the 16 year study period, 114 patients underwent mitral valve replacement (MVR), aortic valve replacement (AVR) or mitral and aortic valve replacements (MAVR). There were 48 males and 66 females (ratio of 1:1.4). Their ages ranged from 6-18 years (median 14 years). Follow up was 94.7% complete. Median follow up was 9.1 years. MVR was performed in 91 (79.8%) patients, AVR in 13 (11.4%) and MAVR in 10 (8.8%) patients. Tricuspid valve repair was performed concomitantly in 45 (39.5%) patients.
    There were 6 early deaths (5.3%) and 6 late deaths (5.3%). Actuarial survival at 1 and 15 years were 98.1% and 94.0% respectively. Prosthetic valve thrombosis (PVT) occurred in 4 patients (0.45% per patient-year). Two reoperations were performed (0.22% per patient-year). There was 1(0.9%) each of major bleeding event, nonstructural dysfunction and prosthetic valve endocarditis.
    Conclusion
    Mechanical valve replacement in this age group has acceptable early and late mortality. PVT is the main cause of morbidity and so measures to prevent PVT must be intensified.