Related Experiment Video
Updated: Aug 17, 2026
A Simplified Model for Heterotopic Heart Valve Transplantation in Rodents
Published on: September 21, 2021
Mitral-valve replacement in children under 6 years of age
T Günther1, D Mazzitelli, C Schreiber
1Klinik für Herz- und Gefässchirurgie, Deutsches Herzzentrum, Klinik an der Technischen, Universität München, Lazarettstrasse 36, 80636, Munich, Germany. chinfo@dhm.mhn.de
Insights
Mitral valve replacement (MVR) in children under six carries high risks, but mechanical prostheses offer satisfying long-term outcomes. Careful management of anticoagulation is key for these young patients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Congenital mitral-valve disease often necessitates surgical intervention.
- Reconstructive surgery is preferred, but mitral valve replacement (MVR) is essential for severe cases or failed repairs in young children.
Purpose of the Study:
- To analyze the outcomes of MVR in patients younger than six years.
- To evaluate the safety and efficacy of mechanical versus bioprosthetic valves in this pediatric population.
Main Methods:
- Retrospective analysis of 35 patients under six years old who underwent MVR between 1974 and 1997.
- Implantation of mechanical prostheses in 83% of cases; assessment of patient demographics, indications for surgery, and prosthesis types/sizes.
- Evaluation of hospital mortality, late mortality, reoperation rates, and valve-related complications.
Main Results:
- Overall hospital mortality was 17.1%, with a decrease observed in later years (11.5% from 1986-1997).
- Actuarial survival after 20 years was 51.2%. Reoperation was required in 23% of patients, with freedom from reoperation at 10 years at 50%.
- Common complications included thromboembolism and structural deterioration. Most survivors achieved good functional status (NYHA class I) and sinus rhythm, with many off medication.
Conclusions:
- MVR in young children remains a high-risk procedure, but offers satisfying long-term results.
- Mechanical prostheses are preferred due to good tolerance and a low incidence of anticoagulation-related complications.
- MVR is a viable option for children with congenital mitral valve disease when reconstructive surgery fails or is not feasible.
Objective:
In patients with congenital mitral-valve disease, reconstructive surgery is the primary goal. However, in cases with severely dysplastic valves or failed repair, mitral-valve replacement (MVR) is the only option. We analyzed, retrospectively, data of 35 patients younger than 6 years of age, who underwent MVR at our institution.
Methods:
Between 1974 and 1997, 35 children underwent MVR. The ages ranged from 2.7 months to 5.5 years (mean=1. 9+/-1.7 years) and body weight varied between 3.2 and 16.7 kg (mean=8.2+/-4 kg). The main indication (57%) for valve replacement was severe mitral-valve insufficiency. Eighteen patients (51%) had undergone at least one previous reconstructive operation (mean=1. 46+/-1.86 years) before the MVR. In 29 cases (83%), mechanical prostheses were implanted. Six patients received a bioprosthesis. The size of the prostheses ranged between 14 and 27 mm.
Results:
The overall hospital mortality was 17.1% (6/35), and decreased from 33 (1974-1985) to 11.5% (1986-1997). Seven children died late. The actuarial survival after 20 years was 51.2+/-13.3%. Eight patients (23%) required 10 reoperations (8.2%/100 patient-years). Freedom from reoperation at 10 years was 50+/-22%. Valve-related complications were thrombo-embolism (n=2; 1.6%/100 patient-years), hemorrhage (n=1; 0.8%/100 patient-years), structural deterioration (n=3; 2.5%/100 patient-years) and non-structural dysfunction (n=3; 2. 5%/100 patient-years). Follow-up is 96% complete, with a total of 122 patient-years (mean=4.2+/-4.7 years). Eighty six percent of the patients are in New York Heart Association (NYHA) class I, 95% have sinus rhythm and 59% do not need medication. All survivors, except for those who received a bioprosthesis, were placed on a regimen of Phenprocoumon (Marcumar((R))), aiming to maintain the International Normalized Ratio (INR) between 2.5 and 3.5. In one third of these children, self-management of oral anticoagulation was performed either by the patients or their parents.
Conclusions:
MVR in small children still carries a high risk. In our experience, the long-term results are satisfying. After failed reconstructive surgery, or as a primary procedure, we prefer mechanical prostheses. They are well tolerated and the incidence of anticoagulation-related complications is low.
Related Concept Videos
01:27Mitral Valve Prolapse I: Introduction
01:22Mitral Valve Prolapse II: Assessment and Management
01:19Mitral Valve Prolapse III: Nursing Management
01:25Mitral Regurgitation III: Medical Management
01:22Mitral Stenosis I: Introduction
01:26Mitral Stenosis III: Medical Management