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Published on: May 26, 2023
Outcomes of mitral valve replacement with bileaflet mechanical prosthetic valve in children
Takuya Okamoto1, Toshihide Nakano2, Masami Goda2
1Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan. ma05026okataku@yahoo.co.jp.
Insights
Outcomes after pediatric mitral valve replacement with mechanical valves were satisfactory, but reoperations were frequent. Small prosthesis size predicted the need for re-mitral valve replacement in children.
Area of Science:
- Pediatric Cardiac Surgery
- Mechanical Heart Valves
- Prosthetic Valve Outcomes
Background:
- Mitral valve replacement in children presents unique challenges due to growth and development.
- Bileaflet mechanical prosthetic valves are used in pediatric patients, but long-term outcomes require evaluation.
Purpose of the Study:
- To assess outcomes of mitral valve replacement using bileaflet mechanical valves in pediatric patients.
- To identify predictors of mortality and reoperation after this procedure.
Main Methods:
- Retrospective review of 49 children undergoing mitral valve replacement (1982-2015).
- Analysis of surgical results, survival rates, complication-free rates, and reoperation rates.
- Investigation of predictors for mortality and reoperation.
Main Results:
- No operative mortality; 8 late deaths occurred over a median 13-year follow-up.
- Actuarial survival rates at 5, 10, and 15 years were 89.5%, 84.2%, and 80.7%, respectively.
- Reoperation for mitral valve replacement was required in 19 patients; initial valve diameter < 19 mm predicted reoperation.
Conclusions:
- Mitral valve replacement with bileaflet mechanical valves in children yields satisfactory survival.
- Complications, particularly re-mitral valve replacement, are frequent.
- Small prosthesis size is a significant predictor for reoperation in pediatric mitral valve replacement.
Objectives:
We examined the outcomes following mitral valve replacement with bileaflet mechanical prosthetic valve in children and identified the predictors for mortality and reoperation.
Methods:
Medical records from 49 children who underwent mitral valve replacement between 1982 and 2015 were reviewed retrospectively. Median age and body weight at initial mitral valve replacement were 2.4 years and 9.7 kg, respectively. The median follow-up was 13 years. Surgical results and predictors for mortality and reoperation were investigated.
Results:
There was no operative mortality; eight late deaths occurred. The actuarial survival rates were 89.5%, 84.2%, and 80.7% at 5, 10, and 15 years, respectively, after initial mitral valve replacement. The actuarial freedom rates from related complications were 89.5%, 78.3%, and 70.7% at 5, 10, and 15 years, respectively. Nineteen patients required 1st re-mitral valve replacement at a median of 5.9 years; six of these 19 required 2nd re-mitral valve replacement at a median of 8.9 years after 1st re-MVR. The actuarial freedom rates from re-mitral valve replacement were 86.0%, 56.8%, and 44.2% at 5, 10, and 15 years, respectively. No predictor for death was determined; however, the predictor for re-mitral valve replacement was initial valve diameter less than 19 mm.
Conclusions:
Survival outcomes among children after mitral valve replacement with bileaflet mechanical prosthetic valve in biventricular heart were satisfactory. However, complications, including re-mitral valve replacement, were frequent and the predictor was of a small prosthesis size.
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