Early and mid-term outcome of pediatric congenital mitral valve surgery

Abstract

Background:Congenital lesions of the mitral valve are relatively rare and are associated with a wide spectrum of cardiac malformations. The surgical management of congenital mitral valve malformations has been a great challenge.Objectives:The aim of this study was to evaluate the early and intermediate-term outcome of congenital mitral valve (MV) surgery in children and to identify the predictors for poor postoperative outcomes and death.Patients and Methods:In this retrospective study, 100 consecutive patients with congenital MV disease undergoing mitral valve surgery were reviewed in 60-month follow-up (mean, 42.4 ± 16.4 months) during 2008 - 2013. Twenty-six patients (26%) were under one-year old. The mean age and weight of the patients were 41.63 ± 38.18 months and 11.92 ± 6.12 kg, respectively. The predominant lesion of the mitral valve was MV stenosis (MS group) seen in 21% and MR (MR group) seen in 79% of the patients. All patients underwent preoperative two-dimensional echocardiography and then every six months after surgeryResults:Significant improvement in degree of MR was noted in all patients with MR during postoperative and follow-up period in both patients with or without atrioventricular septal defect (AVSD) (P = 0.045 in patients with AVSD and P = 0.008 in patients without AVSD). Decreasing trend of mean gradient (MG) in MS group was statistically significant (P = 0.005). In patients with MR, the mean pulmonary artery pressure (PAP) had improved postoperatively (P < 0.001). Although PAP in patients with MV stenosis was reduced, this reduction was not statistically significant (P = 0.17). In-hospital mortality was 7%. Multivariate analysis demonstrated that age (P < 0.001), weight (P < 0.001), and pulmonary stenosis (P = 0.03) are strong predictors for mortality. Based on the echocardiography report at the day of discharge from hospital, surgical results were optimal (up to moderate degree for MR group and up to mild degree for MS group) in 85.7% of patients with MS and in 76.6% of patients with MR. Age (P = 0.002) and weight (P = 0.003) of patients are strong predictors for surgical success in multivariate analysis.Conclusions:Surgical repair of the congenital MV disease yields acceptable early and intermediate-term satisfactory valve function and good survival at intermediate-term follow-up. Strong predictors for poor surgical outcome and death were age smaller than 1 year, weight smaller or equal than 6 kg, and associated cardiac anomalies such as pulmonary stenosis.

Personalised Warfarin Dosing in Children Post-cardiac Surgery

“…To date, only one prospective clinical study of children has been conducted to compare genotype-guided warfarin dose individualisation with the conventional, weight-adjusted dosing approach [12]. Genotype-guided dosing was found to significantly decrease the time to stable dose and hospital stay days [12]. Warfarin dose individualisation in children using PK/PD models has not been investigated.…”

Height, VKORC1 1173, and CYP2C9 Genotypes Determine Warfarin Dose for Pediatric Patients with Kawasaki Disease in Southwest China

“…Studies indicated that patients with VKORC1 − 1639 AA require significantly lower warfarin doses than the GG or GA groups. Avisa et al [5] reported opposite results, with only two patients with the AA genotype not receiving higher doses. Studies indicated that 1173 and − 1639 SNP are in strong linkage disequilibrium (LD), and even the three SNPs VKORC1 (1173, − 1639, and 3730) might be in LD.…”

“…Warfarin dosage models based on pharmacogenetics have been generated for adults, but are not used in pediatric patients due to excessive estimation of warfarin dosage. Meanwhile, studies have explored the efficiency of warfarin dose based on genotyping [5, 20, 21], but most of them had small sample sizes and unclear findings. To further define warfarin pharmacogenetics in children, multi-center, randomized control trials are warranted.…”

“…Warfarin is a racemic mixture of ( R )-warfarin and (S)-warfarin. ; (S)-warfarin, metabolized by CYP2C9, is three to five times more active as anticoagulant than ( R )-warfarin [5, 6]. The most common mutation sites of CYP2C9 are *2 (SNP rs1799853) and *3 (SNP rs1057910), and activity of mutant CYP2C9 is reduced by 20–80%.…”

Letter to the editor on “early and mid-term outcome of pediatric congenital mitral valve surgery”

“…We read with great interest the study by Baghaei et al, and we congratulate the researchers for the noteworthy objective and results ( 1 ). The author reviewed 100 consecutive pediatric patients with congenital mitral valve disease that underwent mitral valve surgery through median sternotomy.…”