Thromboembolic and Other Events Following Valve Replacement in a Pediatric Population Treated with Antiplatelet Agents

• Published in: The Annals of thoracic surgery Vol. 43; no. 3; pp. 285 - 287
• Main Authors: McGrath, Lynn B., Gonzalez-Lavin, Lorenzo, Eldredge, W. Jay, Colombi, Maria, Restrepo, Dario
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.1987; Elsevier Science
• Subjects: Adolescent; Adult; Anticoagulants - therapeutic use; Aortic Valve; Biological and medical sciences; Blood Platelets - drug effects; Blood. Blood coagulation. Reticuloendothelial system; Child; Child, Preschool; Drug Evaluation; Follow-Up Studies; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis - mortality; Humans; Medical sciences; Mitral Valve; Pharmacology. Drug treatments; Postoperative Care; Postoperative Complications - epidemiology; Postoperative Complications - mortality; Postoperative Complications - prevention & control; Thromboembolism - epidemiology; Thromboembolism - mortality; Thromboembolism - prevention & control; Tricuspid Valve; Human; Heart; Chemotherapy; Cardiac valvular disease; Prosthesis; Surgery; Cardiovascular disease; Thromboembolism; Heart valve; Child; Antiplatelet agent
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(10)60614-5

To determine if anticoagulation therapy is necessary after valve replacement with the St. Jude Medical prosthesis in young subjects, 30 consecutive patients were studied. They ranged in age from 4 to 20 years, and each had undergone valve replacement some time between February, 1982, and June, 1984. There was 1 hospital death (3.3%; 70% confidence limits [CL] = 0.4% to 10.9%). The 29 hospital survivors were treated with aspirin and dipyridamole. All patients were followed up. There were 5 late deaths (17.2%; 70% CL = 9% to 27%), at a mean of 8 months postoperatively. Follow-up revealed that 7 thromboembolic events occurred in 7 of the hospital survivors (24.1%; 70% CL = 15% to 35%). Hemiparesis occurred in 1 patient, and documented valve thrombosis and death occurred in another. Transient sensorimotor deficits were found in the 5 other patients. Prosthetic valve endocarditis developed in 1 hospital survivor (3.5%; 70% CL = 0.4% to 11%) and resulted in late death. There were no reoperations in the hospital survivors. We conclude that the St. Jude Medical prosthesis is useful for valve replacement in the young because of its low profile, durability, and hemodynamic characteristics. However, we recommend that these patients receive full anticoagulation therapy.