Related Experiment Videos
Long-term results after Starr-Edwards mitral valve replacement in children aged 5 years or younger
Ryuji Higashita1, Seiichi Ichikawa, Hiroshi Niinami
1Department of Cardiovascular Surgery, Tokyo Women's Medical University, Daini Hospital, Tokyo, Japan.
Insights
Choosing the right size Starr-Edwards mitral valve prosthesis is crucial for pediatric patients. Larger valves (1M) accommodate growth, while smaller ones (OM) require replacement due to patient development.
Area of Science:
- Pediatric Cardiac Surgery
- Prosthetic Valve Design
- Biomaterial Science
Background:
- Pediatric mitral valve replacement necessitates careful consideration of patient growth and prosthesis size.
- Prosthetic valve-patient mismatch is a key factor influencing long-term outcomes in pediatric recipients.
Observation:
- This study reviewed 8 children (≤5 years) who received Starr-Edwards ball valve mitral prostheses (OM or 1M sizes).
- Follow-up ranged from 15 to 27 years, with 100% patient retention.
- No instances of thromboembolism, anticoagulant-related hemorrhage, or prosthetic valve endocarditis were reported.
Findings:
- Smaller Starr-Edwards valves (size OM) were adequate for growth to adolescence but ultimately required re-operation due to hemodynamic compromise.
- Larger Starr-Edwards valves (size 1M) remained hemodynamically satisfactory throughout patient growth.
- The Starr-Edwards ball valve demonstrated excellent durability and a favorable safety profile in this pediatric cohort.
Implications:
- Proper prosthetic valve sizing is critical to avoid re-operation in growing children.
- The Starr-Edwards 1M valve size appears to be a more suitable option for long-term hemodynamic function in pediatric mitral valve replacement.
- These findings inform surgical decisions regarding valve selection in pediatric mitral valve replacement to optimize long-term patient outcomes.
Background:
Mitral valve replacement with prosthetic valves in infants and children requires consideration of multiple variables. When we examined our late follow-up, the effect of the growth of the patient relative to the size of the prosthesis placed was the most important variable predicting late successful results. We reviewed our experience with mitral valve replacement using the Starr-Edwards ball valve in children aged 5 years or younger, focusing on the effect of valve prosthesis-patient mismatch on the long-term results in the growing patient.
Methods:
From August 1974 to June 1986, 8 patients aged 5 years or younger underwent mitral valve replacements using the Starr-Edwards prosthesis size OM in 3 patients and 1M in 5 patients. Model 6320 was used in 1 patient and Model 6120 in the remaining 7 patients.
Results:
Follow-up was 100% from 15 to 27 years (mean, 20 years). No valve-related complications of thromboembolism, anticoagulant-related hemorrhage, or prosthetic valve endocarditis were seen. All patients normally developed to adult size. The range of the valve area index of the 3 patients who received the smaller Starr-Edwards valve (size OM) was 0.97 to 1.24 cm2/m2. Although this size valve was adequate for patient growth to adolescence, in each case valve replacement with a larger valve was required.
Conclusions:
Our long-term review of Starr-Edwards ball valve mitral valve replacement in children aged 5 years or younger shows that the Starr-Edwards ball valve (Models 6320 [1 patient] and 6120 [7 patients]) showed excellent durability, no thromboembolism, and no anticoagulant-related complications. Size OM valves required replacement for hemodynamic reasons because of patient growth; larger size 1M valves remained hemodynamically satisfactory in spite of patient growth.