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Mitral valve replacement using bileaflet mechanical prosthetic valve in the first year of life
M Masuda1, H Kado, T Matsumoto
1Department of Cardiac Surgery, Kyushu University Hospital, Fukuoka, Japan.
Insights
Mitral valve replacement in infants using small mechanical valves shows good mid-term results. This surgery has low operative mortality and a high reoperation-free rate, offering a viable option for infant heart conditions.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Infant mitral valve replacement presents significant surgical challenges.
- Prosthetic valve selection critically impacts outcomes in young patients.
- Small bileaflet mechanical valves are being explored for infant cardiac procedures.
Purpose of the Study:
- To evaluate the operative management and long-term outcomes of mitral valve replacement in infants.
- To assess the efficacy of small bileaflet mechanical prosthetic valves in this pediatric population.
Main Methods:
- Retrospective analysis of 6 infants (3-11 months old) undergoing mitral valve replacement between 1994-1997.
- Use of 16mm or 17mm bileaflet mechanical valves (CarboMedics or St. Jude Medical).
- Warfarin anticoagulation was administered post-surgery.
Main Results:
- No operative mortality observed in the cohort.
- Postoperative pulmonary artery wedge pressure was within acceptable limits (10-12 mmHg).
- At a mean follow-up of 36 months, 100% were free from reoperation and thromboembolic complications, with an 83% actuarial survival rate at 70 months.
Conclusions:
- Mitral valve replacement with small bileaflet mechanical valves is feasible in infants.
- The procedure demonstrates low operative mortality and satisfactory mid-term clinical outcomes.
- This approach offers a promising therapeutic option for complex mitral valve disease in infancy.
Objective:
The operative management and long term outcome of mitral valve replacement in infancy remain a therapeutic challenge. The selection of a prosthetic valve for this particular age group might affect the clinical outcome. Here we present our experience of mitral valve replacement in 6 infants using small bileaflet mechanical prosthetic valves.
Methods:
Between January 1994 and August 1997, 6 infants (their age ranged from 3 months to 11 months, and their body weight from 2978 g to 7403 g) underwent mitral valve replacement using a mechanical valve prosthesis (16 mm CarboMedics prosthetic valve in 5, and 17 mm St. Jude Medical prosthetic valve Hemodynamic Plus in 1). The preoperative morphological features of the mitral valve were stenosis in 1, regurgitation in 3, and a combination of these in 2. The prosthesis was fixed at the annulus in 3, and at the supra-annular position in 3. Anticoagulation was performed using warfarin.
Results:
There was no operative mortality. Postoperative catheterization revealed an acceptable wedge pressure in the pulmonary arteries, ranging from 10 to 12 mmHg. During the mean follow-up period of 36 months, late death due to residual pulmonary hypertension occurred in 1 patient at 10 months after surgery. Excluding this patient, all remaining patients are doing well with no need for repeated operation with no thromboembolic complication. The actuarial survival rate and the reoperation free rate at 70 months are 83 +/- 15% and 100%, respectively.
Conclusion:
Mitral valve replacement using a small size bileaflet mechanical prosthetic valves in infancy can be performed with low operative mortality and with satisfactory mid-term results.