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Mitral valve replacement in children: predictors of long-term outcome
Brian K Eble1, William P Fiser, Pippa Simpson
1Department of Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas 72202, USA.
Insights
Mitral valve replacement in children has high complication rates. Predictors of better outcomes include older age at initial repair and optimal prosthetic valve sizing.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Medical Outcomes Research
Background:
- Mitral valve replacement (MVR) in pediatric patients is linked to significant complications.
- Identifying factors influencing MVR outcomes in children is crucial for improving patient care.
Purpose of the Study:
- To assess predictors of adverse outcomes in children undergoing mitral valve replacement.
- To identify factors associated with long-term survival and reoperation after pediatric MVR.
Main Methods:
- Retrospective review of clinical, surgical, and echocardiographic data from 53 children undergoing 76 MVR procedures (1982-2000).
- Analysis included patient demographics, surgical history, preoperative echocardiographic findings, and long-term follow-up.
- Statistical analysis to identify predictors of mortality, reoperation, and transplant.
Main Results:
- 14 patient deaths (26%) and 5 transplants (36%) occurred. Ten-year freedom from reoperation was 66%.
- Long-term survivors were older at initial repair, had fewer residual cardiac lesions, and underwent fewer additional surgical procedures.
- Survivors demonstrated better preoperative left ventricular function and appropriate prosthetic valve sizing relative to the mitral valve annulus.
Conclusions:
- Adverse outcomes are common after pediatric mitral valve replacement, especially in younger children or those needing complex procedures.
- Preoperative assessment of mitral valve size and left ventricular function is essential for risk stratification.
- Optimizing prosthetic valve selection and surgical approach can improve outcomes in pediatric MVR.
Background:
Mitral valve replacement (MVR) in children has been associated with a high complication rate. We sought to assess predictors of outcomes in children undergoing MVR.
Methods:
A retrospective review of clinical, surgical, and echocardiographic records of patients undergoing MVR was performed. Between 1982 and 2000, 53 children underwent 76 MVR procedures at a median age of 5 years (range, 1 day to 18 years) and weight of 17 kg (range, 3 to 121 kg). Eighteen patients (34%) had more than one MVR. Previous cardiac surgery had been performed in 39 (74%), with 27 (51%) undergoing previous mitral repair. Patients were followed for 9.2 +/- 4.8 (range, 2 to 20) years.
Results:
There were 14 patient deaths, with 6 patients dying within 30 days, and five transplants (36%). Ten-year freedom from reoperation was 66%. Long-term survivors were older at initial repair (7.0 vs 2.5 years, p = 0.02), with a lower incidence of residual cardiac lesions (3% vs 37%, p < 0.001) and a lower incidence of surgical procedures at the time of MVR (31% vs 63%, p = 0.04). Survivors had better left ventricular function preoperatively (ejection fraction, 68% vs 54%; p = 0.001) and placement of a prosthetic valve within 1 z-score of the echocardiographically measured mitral valve annulus (p = 0.02).
Conclusions:
Adverse outcome after MVR is common, particularly in the young child undergoing palliative surgery or requiring additional surgical procedures. Preoperative assessment of mitral valve size and ventricular function is essential for risk stratification of these patients.