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<p>Risk factors for developing prosthetic valve thrombosis (PVT) after systemic atrioventricular valve replacement in patients with functional single ventricles remain poorly understood. Medical records of 39 operations in 28 patients with functional single ventricles who underwent systemic atrioventricular valve replacement between 1998 and 2021 were retrospectively reviewed. Clinical variables were compared between patients with and without PVT. Median age at operation was 20 (IQR: 10–57) months; body weight was 7.8 (4.9–11.4) kg. Valve size was 21 (19–22) mm, and ratio of valve size (mm) to weight (kg) was 2.4 (1.8–3.6). Valve replacement was performed before bidirectional Glenn procedure (BDG) in 8 cases, with BDG in 7 cases, between BDG and total cavopulmonary connection (TCPC) in 13 cases, with TCPC in 4 cases, and after TCPC in 7 cases. PVT occurred after 12 of 39 operations (31%). Significant differences existed in median age at operation (12 vs. 26 months, <i>p</i> = 0.003), median weight at operation (4.9 vs. 10.2&#xa0;kg, <i>p</i> = 0.001), and median valve size/weight ratio (3.6 vs. 2.1, <i>p</i> = 0.002) between operations with and without PVT. PVT incidence was higher before TCPC completion: before BDG (4/8 operations, 50%), BDG (3/7, 43%), and between BDG and TCPC (5/13, 38%), compared to TCPC (0/4, 0%) and after TCPC (0/7, 0%) (<i>p</i> &lt; 0.001). Patients who developed PVT were younger and underweight; in these patients, the use of a relatively oversized prosthesis is clinically inevitable. Close monitoring for PVT is warranted, especially before TCPC completion.</p>

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Risk Factors for the Development of Prosthetic Valve Thrombosis After Systemic Atrioventricular Valve Replacement in Pediatric Patients with a Functional Single Ventricle

  • 期刊论文

  • 发表日期：

    2026年5月22日

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  • Yuya Yamada,
  • Kenichiro Yamamura,
  • Ayako Kuraoka,
  • Kiyotaka Go,
  • Yuichi Ishikawa,
  • Toshihide Nakano,
  • Koichi Sagawa

摘要

Risk factors for developing prosthetic valve thrombosis (PVT) after systemic atrioventricular valve replacement in patients with functional single ventricles remain poorly understood. Medical records of 39 operations in 28 patients with functional single ventricles who underwent systemic atrioventricular valve replacement between 1998 and 2021 were retrospectively reviewed. Clinical variables were compared between patients with and without PVT. Median age at operation was 20 (IQR: 10–57) months; body weight was 7.8 (4.9–11.4) kg. Valve size was 21 (19–22) mm, and ratio of valve size (mm) to weight (kg) was 2.4 (1.8–3.6). Valve replacement was performed before bidirectional Glenn procedure (BDG) in 8 cases, with BDG in 7 cases, between BDG and total cavopulmonary connection (TCPC) in 13 cases, with TCPC in 4 cases, and after TCPC in 7 cases. PVT occurred after 12 of 39 operations (31%). Significant differences existed in median age at operation (12 vs. 26 months, p = 0.003), median weight at operation (4.9 vs. 10.2 kg, p = 0.001), and median valve size/weight ratio (3.6 vs. 2.1, p = 0.002) between operations with and without PVT. PVT incidence was higher before TCPC completion: before BDG (4/8 operations, 50%), BDG (3/7, 43%), and between BDG and TCPC (5/13, 38%), compared to TCPC (0/4, 0%) and after TCPC (0/7, 0%) (p < 0.001). Patients who developed PVT were younger and underweight; in these patients, the use of a relatively oversized prosthesis is clinically inevitable. Close monitoring for PVT is warranted, especially before TCPC completion.