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Comparison of mechanical and biological prostheses when used to replace heart valves in children and adolescents with rheumatic fever

Published online by Cambridge University Press:  01 April 2009

Paulo R. Travancas ,
Ana H. Dorigo ,
Luiz C. Simões ,
Sandra C. Fonseca ,
Kátia V. Bloch  and
Gesmar V. Herdy
Paulo R. Travancas*
Affiliation:
Serviço de Cardiologia da Criança e do Adolescente do Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Ana H. Dorigo
Affiliation:
Serviço de Cardiologia da Criança e do Adolescente do Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Luiz C. Simões
Affiliation:
Serviço de Cardiologia da Criança e do Adolescente do Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Sandra C. Fonseca
Affiliation:
Departamento de Epidemiologia e Bioestatística da Universidade Federal Fluminense, Niterói, Brazil
Kátia V. Bloch
Affiliation:
Departamento de Medicina Preventiva da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
Gesmar V. Herdy
Affiliation:
Departamento de Pediatria da Faculdade de Medicina da Universidade Federal Fluminense, Niterói, Brazil
*
Correspondence to: Paulo Renato Figueiredo Travancas, Serviço de Cardiologia da Criança e do Adolescente do Instituto Nacional de Cardiologia, Rua das Laranjeiras 374 4° floor, Laranjeiras, Rio de Janeiro – RJ, BrazilCEP 22240-006. Tel & Fax: 00 55 21 22854594; E-mail: paulotravancas@gmail.com
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Abstract

Objective

To assess the outcomes in children and adolescents with rheumatic fever of the implantation of mechanical as opposed to biological heart valves.

Methods

We assessed 73 patients with rheumatic heart disease under the age of 18 years, who underwent replacement of heart valves between January, 1996, and December, 2005, at the National Institute of Cardiology in Rio de Janeiro, Brazil. Of the group, 71 patients survived, and were divided into a group of 52 receiving mechanical prostheses, and 19 with biological prostheses. We compared endpoints between the groups in terms of mortality, reoperation, haemorrhage, and stroke. Survival curves were estimated using the Kaplan-Meier method and were compared by the Mantel (log-rank) test.

Results

Overall mortality was 8.2%. In those receiving mechanical prostheses, 2 (3.8%) patients died, 5 (9.6%) underwent reoperation, 2 (3.8%) suffered severe haemorrhage, and 3 (5.8%) had strokes. In those receiving biological valves, 2 (10.5%) patients died, and 4 (21%) underwent reoperation. After 2, 4, and 8 years, overall survival was 96%, 93% and 86%, respectively, with a borderline difference between the groups (p = 0.06). The probabilities of remaining free from reoperation (p = 0.13), and from combined endpoints, showed no statistically significant difference between the groups (p = 0.28).

Conclusions

Patients with mechanical prostheses had lower mortality and required fewer reoperations, but when all combined endpoints were considered, the groups did not differ. The biological prosthesis proved to be a good option for cardiac surgery in children and adolescents with difficulties or risks of anticoagulation.

Keywords

Cardiothoracic surgerypaediatric cardiac surgeryrheumatic heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 19 , Issue 2 , April 2009 , pp. 192 - 197
Copyright
Copyright © Cambridge University Press 2009

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