PERFORMANCE OF 96 CARBOMEDICS VALVE REPLACEMENTS IN 75 PATIENTS LESS-THAN 21 YEARS OF AGE

Valve replacement still represents a problem in the very young patient . Between July 1988 and November 1993, 96 CarboMedics mechanical valve s were implanted in 75 patients with a mean age of 11.76 years (range, 5 months to 20 years). The mean preoperative New York Heart Associati on functional class was 3.2, and 89.3% of the patients were in sinus r hythm. The cause was rheumatic in 60%, congenital in 24%, and infectiv e in 12%. Mitral valve replacement was undertaken in 43 patients, aort ic in II, and mitroaortic in 21. Among the 18 patients with congenital defects, 13 required simultaneous repair of their complex lesions. Th e hospital mortality was 12% (9 patients). Cause and age were signific ant factors responsible for mortality. The mortality was 27.8% for pat ients with congenital disease and 6.7% for those with rheumatic defect s (p = 0.0365); it was 40% for patients younger than 2 years, 14.3% fo r those between 3 and 10 years old, and 5.9% for those older than 10 y ears (p 0.0108). The maximum follow-up was 54 months (mean, 18 months) . There were 10 late deaths (15.15%). No embolic events occurred. All patients were on anticoagulation therapy except 2 who were on antiaggr egant therapy. One of them underwent successful reoperation for treatm ent of mitral prosthetic thrombosis. Three reoperations were performed : one for thrombosis, one for perivalvular leak, and one for endocardi tis. The total actuarial survival was 68.19% +/- 7.02%. Freedom from e mbolism was 100%; from thrombosis, 96.72% +/- 3.22%; from severe hemor rhage, 94.94% +/- 3.67%, and from reoperation, 83.07% +/- 9.51%.