Outcomes of Mechanical Mitral Valve Replacement in Children.
Document Type
Article
Publication Date
1-2019
Identifier
DOI: 10.1016/j.athoracsur.2018.07.069; PMCID: PMC7288372
Abstract
BACKGROUND: Mitral valve anomalies in children are rare but frequently severe, recalcitrant, and not often amenable to primary repair, necessitating mechanical mitral valve replacement (M-MVR). This study examined outcomes of a cohort undergoing a first M-MVR at age younger than 21 years.
METHODS: We queried the Pediatric Cardiac Care Consortium, a multi-institutional United States-based cardiac intervention registry, for patients undergoing first M-MVR for 2-ventricle congenital heart disease. Survival and transplant status through 2014 were obtained from Pediatric Cardiac Care Consortium and linkage with the National Death Index and the Organ Procurement and Transplantation Network.
RESULTS: We identified 441 patients (median age, 4.3 years; interquartile range, 1.3 to 10.1 years) meeting study criteria. The commonest disease necessitating M-MVR was atrioventricular canal (44.3%). Early mortality (deathM-MVR) was 11.1%; there was increased risk of early death if age at M-MVR was younger than 2 years (odds ratio, 7.8; 95% confidence interval [CI], 1.1 to 56.6) and with concurrent other mechanical valve placement (odds ratio, 8.5; 95% CI, 2.0 to 35.6). In those surviving more than 90 days after M-MVR, transplant-free survival was 76% at 20 years of follow-up (median follow-up, 16.6 years; interquartile range, 11.9 to 21.3 years). Adjusted analysis in those who survived more than 90 days showed elevated risk of death/transplant for boys (hazard ratio, 1.5; 95% CI, 1.0 to 2.3), age at M-MVR younger than 2 years (10-year survival: hazard ratio, 4.3; 95% CI, 1.2 to 15.1), and nonbileaflet prosthesis placement (hazard ratio, 2.4; 95% CI, 1.3 to 4.3).
CONCLUSIONS: M-MVR is a viable strategy in children with unrepairable mitral valve disease. Age younger than 2 years at the first M-MVR is associated with significant early risk of death and poorer long-term survival.
Journal Title
The Annals of thoracic surgery
Volume
107
Issue
1
First Page
143
Last Page
150
MeSH Keywords
Adolescent; Age Factors; Child; Child, Preschool; Female; Follow-Up Studies; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Infant; Male; Mitral Valve; Prosthesis Design; Reoperation; Retrospective Studies; Survival Rate; Treatment Outcome; United States; Young Adult
Keywords
Adolescent; Age Factors; Child; Child, Preschool; Female; Follow-Up Studies; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Infant; Male; Mitral Valve; Prosthesis Design; Reoperation; Retrospective Studies; Survival Rate; Treatment Outcome; United States; Young Adult
Recommended Citation
Ibezim C, Sarvestani AL, Knight JH, et al. Outcomes of Mechanical Mitral Valve Replacement in Children. Ann Thorac Surg. 2019;107(1):143-150. doi:10.1016/j.athoracsur.2018.07.069
COinS
Comments
Grant support