Replacement of tricuspidal valve with mechanical and biological prostheses in children

To select the most appropriate prosthesis to be implanted in a tricuspidal area, 88 patients under pediatric care were examined. The patients' age varied from 5 months to 15 years and they all had undergone tricuspid valve replacement over a period from 1991 to 2006 were examined. The patients were broken down in two groups: those with mechanical valves (26) and biological ones (62). Hospital mortality was found to be about comparable in both groups: 7.7% (2) in the group with mechanical prostheses and 6.5% (4) in that with biological ones. No valve dysfunction in the early and medium-term follow-up was revealed. The prostheses demonstrated consistent hemodynamic characteristics in both groups. In the long-term follow-up (9-11 years) some abnormalities in valve functioning and linear size of the heart were observed, namely, a rapid increase in biopro-stheses dysfunction caused by earlier angiosteosis and fibrosis of cusps, enlargement of the pulmonary heart as compared to the patients with the implanted mechanical prostheses. These changes necessitated a consecutive repair in the group with bioprostheses in 27.6% of cases (16), while the group with mechanical prostheses required only 16.7% of repeated replacement of the valves (4) in the long-term follow-up. The mechanical valve dysfunction was mainly due to valve thrombosis caused by improper anticoagulant therapy. Hence, mechanical valve replacement accompanied by well-chosen and properly applied anticoagulant therapy would lead to a greater extent of disengagement from repeated repair (91.7%) as compared with bioprostheses (73.3%) by the 9th year after original surgery.