Revisiting prosthesis choice in mitral valve replacement in children: Durable alternatives to traditional bioprostheses

Choi, Perry S.; Sleeper, Lynn A.; Lü, Minmin; Upchurch, Patrick A.; Baird, Christopher W.; Emani, Sitaram M.

doi:10.1016/j.jtcvs.2020.04.173

Cited by 24 publications

(12 citation statements)

References 29 publications

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“…Currently, valve repair is the standard procedure for surgical management of mitral valve diseases in children, and it is associated with low morbidity and better survival compared to MVR 6 . However, MVR remains a high-risk procedure with operative mortality rates of 0–36% 4 , 7 , 8 , despite the recent advances in surgical techniques and valves available. In addition, previous studies had shown increased mortality after MVR in children less than 5 years, and this mortality rate was even higher in children less than 2 years 9 , 10 .…”

Section: Discussionmentioning

confidence: 99%

Mitral valve replacement in infants and younger children

Elmahrouk

Mashali

Ismail

et al. 2021

Sci Rep

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Data on mitral valve replacement (MVR) in young children is still limited. Our objective was to evaluate MVR in children below 5 years and identify factors affecting the outcomes. This retrospective study included 29 patients who had MVR from 2002 to 2020. We grouped the patients into two groups according to their age: age ≤ 24 months (n = 18) and > 24 months (n = 11). Primary cardiac diagnoses were Shone complex (n = 7; 24%), isolated congenital mitral valve abnormality (n = 11; 38%), and complete atrioventricular septal defect (n = 3; 10%). The median age was 19 month (25th–75th percentile: 11–32) and 59% were females (n = 17). The hemodynamic lesions were mitral regurgitation in 66%, mitral stenosis in 10%, and combined mitral stenosis and regurgitation in 24% of the patients. St. Jude mitral valve was the most common valve implanted (n = 19, 66%), followed by CarboMedics in 21% of the patients (n = 6). The mitral valve was implanted in the supra-annular position in 6 cases (21%). Preoperative and operative data were comparable between both groups. There was no association between valve size and position with postoperative heart block (P > 0.99, for both). The median follow-up duration was 19.4 months (8.6–102.5). Nine patients had mitral valve reoperation, six had MVR, and three had clot removal from the mitral valve. There was no effect for age group on reoperation (SHR 0.89 (95% CI 0.27–2.87), P = 0.84). Valve size significantly affected reoperation (SHR 0.39 (95% CI 0.18–0.87), P = 0.02). The supra-annular position was associated with an increased risk of reoperation (SHR 3.1 (95% CI 1.003–9.4), P = 0.049). There was no difference in survival according to the age (Log-rank P = 0.57) or valve size (Log-rank P = 0.66). Mitral valve replacement in children is associated with low morbidity and mortality. The risk of reoperation could be affected by the valve size and position rather than the age.

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Section: Discussionmentioning

confidence: 99%

Mitral valve replacement in infants and younger children

Elmahrouk

Mashali

Ismail

et al. 2021

Sci Rep

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“…In the current issue of the Journal, Choi and colleagues 1 from the Boston Children's Hospital elegantly compare the demographics and outcomes of children undergoing mitral valve replacement (MVR) based on the prosthesis valve type selected at operation. The primary outcome was freedom from re-replacement, whereas secondary outcomes were transplant-free survival and incidence of bleeding/thromboembolic events.…”

Section: Matteo Trezzi MDmentioning

confidence: 99%

Commentary: Taking innovation to heart in pediatric mitral valve replacement

Trezzi

2021

The Journal of Thoracic and Cardiovascular Surgery

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“…15 Furthermore, over time, these patients require valve re-replacement secondary to prosthesis-patient mismatch with somatic growth and early prosthetic dysfunction that predisposes them to worse late outcomes. 8,16…”

Section: Introductionmentioning

confidence: 99%

“…15 Furthermore, over time, these patients require valve rereplacement secondary to prosthesis-patient mismatch with somatic growth and early prosthetic dysfunction that predisposes them to worse late outcomes. 8,16 Long-term outcomes following mechanical mitral valve replacement (mMVR) in the pediatric population are limited to a few cohorts with small sample sizes or select groups, such as patients less than 5 years of age. 9,13,14,17 We therefore sought to assess early and late outcomes in young children and older children undergoing mMVR, analyzing predictors of rereplacement and late death over 3 decades at a large tertiary care institution.…”

Section: Introductionmentioning

confidence: 99%

What Factors Should Be Considered to Improve Outcome of Mechanical Mitral Valve Replacement in Children?

Elsisy

Dearani

Ashikhmina

et al. 2021

World J Pediatr Congenit Heart Surg

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Objective: To identify risk factors for pediatric mechanical mitral valve replacement (mMVR) to improve management in this challenging population. Methods: From 1993 to 2019, 93 children underwent 119 mMVR operations (median age, 8.8 years [interquartile range [IQR]: 2.1-13.3], 54.6% females) at our institution. Twenty-six (21.8%) patients underwent mMVR at ≤2 years and 93 (78.2%) patients underwent mMVR at >2 years. Median follow-up duration was 7.6 years [IQR: 3.2-12.4]. Results: Early mortality was 9.7%, but decreased with time and was 0% in the most recent era (13.9% from 1993 to 2000, 7.3% from 2001 to 2010, 0% from 2011 to 2019, P = .04). It was higher in patients ≤2 years compared to patients >2 years (26.9% vs 2.2%, P < .01). On multivariable analysis for mitral valve reoperation, valve size <23 mm was significant with a hazard ratio of 5.38 (4.87-19.47, P = .01);. Perioperative stroke occurred in 1% and permanent pacemaker was necessary in 12%. Freedom from mitral valve reoperation was higher in patients >2 years and those with a prosthesis ≥23 mm. Median time to reoperation was 7 years (IQR: 4.5-9.1) in patients >2 years and 3.5 years (IQR: 0.6-7.1) in patients ≤2 years ( P = .0511), but was similar between prosthesis sizes ( P = .6). During follow-up period (median 7.6 years [IQR: 3.2-12.4], stroke occurred in 10%, prosthetic valve thrombosis requiring reoperation in 4%, endocarditis in 3%, and bleeding in 1%. Conclusion: Early and late outcomes of mMVR in children are improved when performed at age >2 years and with prosthesis size ≥23 mm. These factors should be considered in the timing of mMVR.

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Revisiting prosthesis choice in mitral valve replacement in children: Durable alternatives to traditional bioprostheses

Cited by 24 publications

References 29 publications

Mitral valve replacement in infants and younger children

Mitral valve replacement in infants and younger children

Commentary: Taking innovation to heart in pediatric mitral valve replacement

What Factors Should Be Considered to Improve Outcome of Mechanical Mitral Valve Replacement in Children?

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