Options for pediatric heart valve replacement

Abstract

Heart valve replacement is indicated for children with irreparable heart valve disease. These replacements come in a variety of forms including mechanical, xenograft tissue, allograft tissue, and autograft tissue valves. These options each have unique benefits and risks profiles. Mechanical valves are the most structurally durable; however, they represent significant thrombogenic risks and require anticoagulant therapy. Xenograft and homograft tissue valves do not carry the thrombogenic risks found with mechanical valves but also do not have the structural integrity of mechanical valves. Importantly, neither of these options allows for the somatic growth, requiring serial reoperation to implant upsized valves. Autograft implantation and partial heart transplantation each allow for the implantation of growing valves; however, autografts require for either a mechanical or bioprosthetic valve to be fitted into another valve position and PHT requires immunosuppressive medication to allow for the growth of the valve. In summary, outcomes of valve implantation in the pediatric population are significantly subpar compared to the outcomes enjoyed by the adult population. To remedy this, further innovation is needed in heart valve replacement technology.

Keywords: Congenital heart disease; bioprosthetic heart valves; mechanical heart valves; partial heart transplantation; valve disease; valve replacement.