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Published on: June 14, 2017
Outcomes of Mechanical Mitral Valve Replacement in Children
Chizitam Ibezim1, Amber Leila Sarvestani1, Jessica H Knight2
1Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
Insights
Mechanical mitral valve replacement (M-MVR) is a viable strategy for children with severe mitral valve disease. However, M-MVR before age 2 increases early death risk and lowers long-term survival rates.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Mitral valve anomalies in children are rare, severe, and often require mechanical mitral valve replacement (M-MVR).
- Primary repair is frequently not feasible for these complex pediatric heart conditions.
Purpose of the Study:
- To examine the outcomes of first-time mechanical mitral valve replacement (M-MVR) in children younger than 21 years.
- To identify risk factors associated with early mortality and long-term survival after M-MVR in pediatric patients.
Main Methods:
- Utilized the Pediatric Cardiac Care Consortium registry for patients undergoing their first M-MVR for 2-ventricle congenital heart disease.
- Obtained survival and transplant status through registry linkage with the National Death Index and Organ Procurement and Transplantation Network.
Main Results:
- Identified 441 patients; atrioventricular canal defect was the most common indication (44.3%).
- Early mortality (<90 days) was 11.1%, with increased risk for patients <2 years old and those with concurrent mechanical valve placement.
- At 20 years, transplant-free survival was 76%; risk factors for death/transplant included male sex, age <2 years at M-MVR, and nonbileaflet prosthesis.
Conclusions:
- Mechanical mitral valve replacement (M-MVR) is a feasible approach for pediatric patients with irreparable mitral valve disease.
- Performing M-MVR in children younger than 2 years is linked to higher early mortality and diminished long-term survival outcomes.
Background:
Mitral valve anomalies in children are rare but frequently severe, recalcitrant, and not often amenable to primary repair, necessitating mechanical mitral valve replacement (M-MVR). This study examined outcomes of a cohort undergoing a first M-MVR at age younger than 21 years.
Methods:
We queried the Pediatric Cardiac Care Consortium, a multi-institutional United States-based cardiac intervention registry, for patients undergoing first M-MVR for 2-ventricle congenital heart disease. Survival and transplant status through 2014 were obtained from Pediatric Cardiac Care Consortium and linkage with the National Death Index and the Organ Procurement and Transplantation Network.
Results:
We identified 441 patients (median age, 4.3 years; interquartile range, 1.3 to 10.1 years) meeting study criteria. The commonest disease necessitating M-MVR was atrioventricular canal (44.3%). Early mortality (death <90 days after M-MVR) was 11.1%; there was increased risk of early death if age at M-MVR was younger than 2 years (odds ratio, 7.8; 95% confidence interval [CI], 1.1 to 56.6) and with concurrent other mechanical valve placement (odds ratio, 8.5; 95% CI, 2.0 to 35.6). In those surviving more than 90 days after M-MVR, transplant-free survival was 76% at 20 years of follow-up (median follow-up, 16.6 years; interquartile range, 11.9 to 21.3 years). Adjusted analysis in those who survived more than 90 days showed elevated risk of death/transplant for boys (hazard ratio, 1.5; 95% CI, 1.0 to 2.3), age at M-MVR younger than 2 years (10-year survival: hazard ratio, 4.3; 95% CI, 1.2 to 15.1), and nonbileaflet prosthesis placement (hazard ratio, 2.4; 95% CI, 1.3 to 4.3).
Conclusions:
M-MVR is a viable strategy in children with unrepairable mitral valve disease. Age younger than 2 years at the first M-MVR is associated with significant early risk of death and poorer long-term survival.
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