Valve replacement in children under twenty years of age. Experience with the Björk-Shiley prosthesis.

Prosthetic valve replacement in young patients has been reported to be associated with a high mortality and morbidity because of valve-related problems. Of 549 patients undergoing valve replacement with the Björk-Shiley valve prosthesis, 136 were under the age of 20 years. Sixty-four patients were under 16 years of age, the youngest being 6 years old. Of the 136 patients, 61 underwent mitral valve replacement, 50 received an aortic valve, and 25 received both aortic and mitral valves. Overall operative mortality was 10.3%. Late mortality over a follow-up period of 6 months to 8 years was 4.4%. Actuarial survival curves up to 8 years of follow-up are presented. Results obtained in this group are compared with those obtained in 413 patients over 20 years of age operated during the same period. Valve thrombosis was not seen in any patient under 20 years of age, but it occurred in 4.13% of the patients over 20 years of age. The incidence of thromboembolism and anticoagulant-related hemorrhage was very low. There has been no instance of structural failure of the valve. Long-term results are excellent, with 90% of the survivors returning to New York Heart Association Functional Class I. The Björk-Shiley valve gives excellent and durable long-term palliation in young patients requiring valve replacement.