Long-Term Survival After Mitral Valve Replacement in Children Aged <5 Years

Abstract

Background-Short-and long-term outcomes after prosthetic mitral valve replacement (MVR) in children aged Ͻ5 years are ill-defined and generally perceived as poor. The experience of the Pediatric Cardiac Care Consortium (45 centers, 1982 to 1999) was reviewed. Methods and Results-MVR was performed 176 times on 139 patients. Median follow-up was 6.2 years (range 0 to 20 years, 96% complete). Age at initial MVR was 1.9Ϯ1.4 years. Complications after initial MVR included heart block requiring pacemaker (16%), endocarditis (6%), thrombosis (3%), and stroke (2%). Patient survival was as follows: 1 year, 79%; 5 years, 75%; and 10 years, 74%. The majority of deaths occurred early after initial MVR, with little late attrition despite repeat MVR and chronic anticoagulation. Among survivors, the 5-year freedom from reoperation was 81%. Age-adjusted multivariable predictors of death include the presence of complete atrioventricular canal (hazard ratio 4.76, 95% CI 1.59 to 14.30), Shone's syndrome (hazard ratio 3.68, 95% CI 1.14 to 11.89), and increased ratio of prosthetic valve size to patient weight (relative risk 1.77 per mm/kg increment , 95% CI 1.06 to 2.97). Age-and diagnosis-adjusted prosthetic size/weight ratios predicted a 1-year survival of 91% for size/weight ratio 2, 79% for size/weight ratio 3, 61% for size/weight ratio 4, and 37% for size/weight ratio 5. Conclusions-Early mortality after MVR can be predicted on the basis of diagnosis and the size/weight ratio. Late mortality is low. These data can assist in choosing between MVR and alternative palliative strategies. (Circulation. 2001;104[suppl I]:I-143-I-147.)

Predictors of Prosthesis Survival, Growth, and Functional Status Following Mechanical Mitral Valve Replacement in Children Aged <5 Years, a Multi-Institutional Study

“…Data are presented as frequencies, rates, and medians with interquartile ranges, mean Ϯ SD, and survival curves. Tests of group differences included t-test, Mann-Whitney U, 2 , and z-test, as appropriate. Estimates of median prosthesis survival times and 95% CIs were obtained by the Kaplan-Meier method.…”

“…We previously reported survival data after initial MVR in this cohort and showed that discrepancy between prosthesis size and body weight was a predictor of outcome, with larger discrepancies (greater prosthetic valve size:body weight ratio) being associated with higher early mortality. 2 We proposed that patients could be chosen for or against the MVR strategy based on these projected mortality risks. A "larger prosthesis" than needed is often not chosen deliberately but rather because of lack of availability of "smaller prosthesis".…”

“…2 The predominant mortality after initial MVR occurred in the early postoperative period with little late attrition. Complications included permanent pacemaker implantation in 16%, bacterial endocarditis in 6%, and cerebrovascular accidents in 5%.…”

“…If one were to choose MVR as a treatment strategy based on the probability of survival, the following questions for the potential survivors would need to be addressed: (1) what is the risk of needing a second MVR; (2) can this risk be predicted at the time of first MVR; (3) would a second MVR result in additional mortality and morbidity; (4) what is the effect of MVR on growth and functional status; and (5) does the rate of somatic growth influence the risk of second MVR? This paper addresses these questions and provides new information regarding the course of a large number of survivors of MVR performed under the age of 5 years.…”

Tissue Engineering of the Atrioventricular Valve: Decellularized Matrix in Ovine Mitral Allograft Model

“…Традиционно применя-емые механические протезы создают трудности для женщин детородного возраста в вопросах планиро-вания семьи. Для больных детского возраста любой протез с жестким каркасом оборачивается необхо-димостью его замены в очень короткие сроки [4][5][6].…”