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Published on: May 26, 2023
Supra-annular mitral valve implantation in very small children
Raffaele Giordano1, Massimiliano Cantinotti, Vitali Pak
1Pediatric Cardiac Surgery, The Heart Hospital, Tuscany Foundation "Gabriele Monasterio", Massa, Italy.
Insights
Mitral valve replacement in very young children offers acceptable outcomes, but complications like thrombotic events require careful monitoring. This surgical option is feasible when other procedures fail.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Surgery
- Mechanical Valve Prostheses
Background:
- Mitral valve replacement (MVR) is an alternative when mitral valvuloplasty is not feasible or successful.
- Very young children with mitral valve disease present unique surgical challenges.
Purpose of the Study:
- To review the experience with supra-annular MVR using mechanical prostheses in very young children.
- To evaluate the feasibility and outcomes of MVR in this pediatric population.
Main Methods:
- Seven children (4-35 months) underwent MVR with mechanical prostheses in the supra-annular position.
- A biatrial transeptal incision was used for improved surgical exposure.
- Patients had congenital or rheumatic mitral valve defects, with most having prior cardiac procedures.
Main Results:
- All patients received CarboMedics mechanical prostheses without operative or late mortality.
- Follow-up revealed two patients (28.6%) required reoperation due to thrombotic pannus formation.
- One patient needed prosthesis replacement due to complications.
Conclusions:
- Supra-annular MVR is a feasible secondary option for children with small mitral annuli when valvuloplasty is unsuitable.
- Early and mid-term outcomes are acceptable, but thrombotic complications are a concern.
- Careful patient selection and monitoring are essential for successful MVR in pediatric cases.
Objective:
Mitral valve replacement (MVR) is a surgical option when mitral valvuloplasty is not feasible/successful. This study reviews our experience with MVR in very young children.
Methods:
From July 2004 to January 2014, seven children (mean age 13.3 ± 11.2 months; range 4 months to 35 months; mean body weight 6.0 ± 2.2 kg) underwent MVR with a mechanical prosthesis in the supra-annular position. To provide better exposure in the left atrium, we performed in all but one case a biatrial transeptal incision according to Guiraudon. Six patients had congenital defects of the mitral valve and one had rheumatic. Six patients had undergone previous cardiosurgical procedures.
Results:
All patients were implanted with a CarboMedics (CarboMedics, Austin, TX, USA) mechanical prosthesis. Mean prosthesis size was 19.0 ± 3.1 mm (range 16 to 25). There were no cases of operative or late mortality. At follow-up (mean 67.1 ± 34.8 months; range 25 to 108 months) two patients (28.6%) required reoperation both for thrombotic pannus formation over the disc at two and three months from first operation, respectively; only in one case was replacement necessary.
Conclusion:
Supra-annular MVR may be considered a feasible secondary surgical option in children with a small annulus when mitral valvuloplasty is unsuccessful or unsuitable. Early and mid-term outcomes are acceptable but complications are not uncommon, especially related to thrombotic events.
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