Related Experiment Video
Updated: May 7, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Long-term survival after mitral valve replacement in children aged <5 years: a multi-institutional study
C A Caldarone1, G Raghuveer, C B Hills
1Department of Surgery, University of Iowa College of Medicine, Iowa City, IA, USA. christopher-caldarone@uiowa.edu
Insights
Outcomes for pediatric mitral valve replacement (MVR) in young children are better than previously thought. Early mortality is predictable by diagnosis and valve size, with low late mortality, aiding treatment decisions.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Outcomes for prosthetic mitral valve replacement (MVR) in children under 5 years old are not well-defined and are generally considered poor.
- This study reviews the experience of the Pediatric Cardiac Care Consortium from 1982 to 1999.
Purpose of the Study:
- To evaluate the short- and long-term outcomes of prosthetic mitral valve replacement (MVR) in children younger than 5 years.
- To identify predictors of mortality and reoperation in this patient population.
Main Methods:
- A retrospective review of 176 mitral valve replacement (MVR) procedures performed on 139 patients aged <5 years.
- Median follow-up was 6.2 years with 96% completeness.
- Multivariable analysis was used to identify predictors of death.
Main Results:
- Patient survival at 1, 5, and 10 years was 79%, 75%, and 74%, respectively.
- Complications included heart block (16%), endocarditis (6%), thrombosis (3%), and stroke (2%).
- Predictors of early death included complete atrioventricular canal, Shone's syndrome, and increased prosthetic valve size-to-weight ratio.
Conclusions:
- Early mortality after pediatric mitral valve replacement (MVR) can be predicted by diagnosis and the prosthetic size-to-weight ratio.
- Late mortality is low, and freedom from reoperation at 5 years is 81%.
- These findings can help guide treatment decisions between MVR and palliative strategies in young children.
Background:
Short- and long-term outcomes after prosthetic mitral valve replacement (MVR) in children aged <5 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 1.9+/-1.4 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.
Related Concept Videos
01:27Mitral Valve Prolapse I: Introduction
01:22Mitral Valve Prolapse II: Assessment and Management
01:25Mitral Regurgitation III: Medical Management
01:22Mitral Stenosis I: Introduction
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
01:26Mitral Stenosis III: Medical Management