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Redo mitral valve replacement in children
Kirk R Kanter1, Joseph M Forbess, Paul M Kirshbom
1Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA. kkanter@emory.edu
The Annals of Thoracic Surgery
|July 26, 2005
Summary
Redo mitral valve replacement (MVR) in children is safe, with low mortality. Many children eventually need heart transplantation, possibly due to delayed referrals for redo MVR.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Surgery
- Pediatric Cardiology
Background:
- Mitral valve repair is effective, but some children require mitral valve replacement (MVR).
- A subset of these children subsequently need reoperation, termed redo MVR.
Purpose of the Study:
- To evaluate the safety and outcomes of redo mitral valve replacement in pediatric patients.
- To identify indications for reoperation and long-term results.
Main Methods:
- Retrospective review of 22 redo MVR procedures in 21 children (aged 1.4-21 years) performed since 1988.
- Analysis of indications for reoperation, initial and subsequent valve types, additional procedures, and outcomes.
Main Results:
- No hospital deaths occurred among the 22 redo MVRs.
- 36% of patients required additional cardiac procedures during reoperation.
- Median prosthesis size increased, and only 9% needed new pacemakers; however, 6 patients ultimately required cardiac transplantation.
Conclusions:
- Redo MVR in children can be performed with low morbidity and mortality.
- Larger prostheses can often be implanted during redo MVR.
- A significant proportion of pediatric patients eventually require heart transplantation, suggesting potential delays in referral for reoperation.