TITLE:
Mortality of Children with Mechanical Valve Prostheses at the CUOMO Cardio-Pediatric Center of University National Hospital of Fann (Dakar)
AUTHORS:
Momar Dioum, Papa Amath Diagne, Amina Hanfaoui, Cheikh Gaye, Ismael I.B. Hanifa, Papa Ousmane Ba, Magalie Kaya, Papa Salmane Ba, Amadou Gabriel Ciss
KEYWORDS:
Morbidity, Mortality, Mechanical Valve, Children, Dakar
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.13 No.9,
September
8,
2023
ABSTRACT: Introduction: Mechanical valve replacement in pediatric age is a dreaded but sometimes
inevitable surgery. The purpose of this study was to determine the mortality of
children with mechanical valve prostheses in the short, medium and long term. Patients
and Methods: This was a retrospective and descriptive study conducted at
the CUOMO cardio-pediatric center at Teaching National Hospital of Fann between
January 1st, 2017 and December 31st, 2021. We included, children
whose age is less than or equal to 16 years of age and who have benefited from
a mechanical valve replacement and with a follow-up period of more than 6
months post-operative in the CUOMO cardio-pediatric center. Patients whose age
at the time of surgery was over 16 years were excluded; patients who have
benefited from bioprosthesis or valvular plastic surgery alone; as well as
patients for whom a follow-up of more than 6 months was not found. Statistical
analyses were carried out using the SPSS (Statistical Package for Social
Science) software version 18 to calculate averages and percentages. Results: We included 85 patients. The average age was 12.84 ± 2.52 years. The male
gender predominated with a sex ratio of 1.65. Dyspnea was found in 96.47% of
children. Pure mitral regurgitation was the most common valve disease found in
67.06%. Rheumatic etiology was noted in 87.06% of cases. Mono valve replacement
was performed in 84.71% of patients and double valve replacement in 15.3% of
cases. Major mechanical complications were reported in 8 patients including 5
severe aortic mismatch cases. Hemorrhagic complications were observed in 4
patients requiring surgery. Hemodynamic complications were dominated by right
ventricle dysfunction in 14 patients. Supraventricular rhythm disorders were
present in 11 patients and one case of ventricular tachycardia. We found six
cases of infectious endocarditis. Eight deaths were recorded with a mortality
rate of 5.88%. Significant predictors of mortality were stage IV dyspnea of
NYHA and preoperative overall heart failure. Conclusion: Our study
showed good results in terms of short-, medium- and long-term mortality.
Complications related to mechanical valve prostheses are not negligible, hence
a rigorous lifetime monitoring after surgery.