5-Year Follow-Up After Valve-Replacement With The St-Jude Medical Valve In Infants And Children

Since 1979, 34 infants and children, 3 weeks to 17 years of age, have undergone cardiac valve replacement with a St. Jude Medical (SJM) prosthesis at our institution. Seventeen children underwent mitral valve replacement (MVR), 16 aortic valve replacement (AVR), and one pulmonary valve replacement. Three hospital deaths were associated with MVR and complex congenital heart disease. All surviving patients were functional in class I. A cumulative 89.1 patient-years of follow-up were analyzed to evaluate valve-related mortality and morbidity. Late complications included thromboembolus (one patient), anticoagulant-related hemorrhage (one patient), and perivalvular leak (one patient). One of six late deaths resulted from mitral valve thrombosis. Actuarial 5 year survival for patients who underwent AVR was 100%, but it was 53% for MVR (p = .03). Freedom from significant morbidity and mortality for up to 5 years after operation was 92 +/- 7% for those who underwent AVR and 45 +/- 16% for those who underwent MVR. Patient-related factors appear to account for an increased rate of complications after MVR. Because of difficulties with achieving anticoagulation with warfarin, aspirin therapy should be used for patients less than 5 years of age, while older patients can be managed with warfarin. The SJM valve is a satisfactory cardiac valve substitute for the pediatric age group.