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Mitral valve replacement with mechanical prostheses in children: improved operative risk and survival

C Alexiou1, M Galogavrou, Q Chen

  • 1Department of Cardiac Surgery, The General Hospital, Southampton, UK.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|June 26, 2001
PubMed

Insights

Mechanical mitral valve replacement (MVR) in children has a low operative risk, especially after 1990. Late survival is improved in older children and those without atrioventricular septal defects, with overall outcomes significantly better in the current era.

Area of Science:

  • Pediatric Cardiac Surgery
  • Mechanical Heart Valve Prostheses
  • Valvular Heart Disease Management

Background:

  • Mitral valve replacement (MVR) in children presents unique challenges due to growth and developmental considerations.
  • Mechanical prostheses are an option for pediatric MVR, but their long-term outcomes require careful evaluation.
  • Assessing early and late results is crucial for optimizing surgical strategies in pediatric valvular heart disease.

Purpose of the Study:

  • To evaluate the early and late outcomes of mechanical mitral valve replacement (MVR) in pediatric patients.
  • To identify factors influencing survival and complications following pediatric MVR with mechanical prostheses.

Main Methods:

  • A retrospective analysis of 44 consecutive children undergoing mechanical MVR between 1981 and 2000.
  • Patient data included age, disease etiology, valve function (regurgitation/stenosis), and concomitant procedures.
  • Comprehensive follow-up assessed operative mortality, re-operations, thromboembolic events, bleeding, and survival rates.

Main Results:

  • Overall operative mortality was 14%, significantly reduced from 31% before 1990 to 3.6% after 1990 (P=0.02).
  • Ten-year freedom from major adverse events (thromboembolism, infection, bleeding, paravalvular leak) was high (>92%).
  • Ten-year survival was 78%, with significantly better outcomes for children over 5 years old (95.2%) compared to younger children (61%) (P=0.02), and improved survival post-1990 (86% vs. 63%, P=0.04).

Conclusions:

  • Mechanical MVR in children can be performed with low operative risk in the current era.
  • Late survival is favorable, particularly in older children and those without atrioventricular septal defects.
  • Outcomes have substantially improved during the 1990s, indicating advancements in surgical techniques and perioperative care.
Abstract

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