Intermediate-term results in pediatric aortic valve replacement

Background. Aortic valve replacement (AVR) in children is now more commonly performed with human tissue valves. Methods. The results of 100 consecutive pediatric AVRs (50 mechanical, 50 h uman) were reviewed. Results. There were five perioperative deaths in the mechanical group and o ne in the human group (p = 0.2). Late complications in the mechanical group included 4 late deaths, 2 cases of endocarditis, 3 thromboembolic complica tions, and 10 reoperations on the aortic valve. In the human group, there w ere no late deaths, 2 reoperations for allograft aortic valve deterioration (both in Marfan's patients), and 1 reoperation for allograft pulmonary val ve stenosis. Four-year actuarial survival was 83% in the mechanical group a nd 98% in the human group (p = 0.02). Four-year actuarial survival free of all valve-related complications was 61% in the mechanical group and 88% in the human group (p = 0.008). Conclusions. Human valves in children requiring AVR provide superior interm ediate-term survival and freedom from valve-related complications compared to mechanical valves. Marfan's syndrome may represent a rare remaining cont raindication for human AVR in children. (C) 1999 by The Society of Thoracic Surgeons.