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Mitral Valve Replacement With the 15-mm Mechanical Valve: A 20-Year Multicenter Experience

Rinske J IJsselhof1, Martijn G Slieker2, Mark G Hazekamp3

  • 1Division of Pediatrics, Department of Pediatric Cardiac Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

The Annals of Thoracic Surgery
|January 22, 2020
PubMed
Abstract

Insights

Mitral valve replacement using the 15-mm St Jude Medical prosthesis is safe for infants, with low mortality. However, prosthesis replacement for outgrowth is common, occurring around 3.5 years, and valve gradients increase over time.

Area of Science:

  • Pediatric cardiology
  • Cardiac surgery
  • Biomedical engineering

Background:

  • Congenital heart defects often necessitate early interventions.
  • Small prosthetic valves pose unique challenges in pediatric cardiac surgery.
  • Evaluating long-term outcomes of small-sized prostheses is crucial for patient management.

Purpose of the Study:

  • To assess early and long-term outcomes of mitral valve replacement in infants using the 15-mm St Jude Medical prosthesis.
  • To evaluate mortality and the need for prosthetic valve replacement.
  • To analyze functional outcomes and complications associated with this small-sized prosthesis.

Main Methods:

  • A multicenter, retrospective cohort study involving 17 infants undergoing mitral valve replacement with the 15-mm St Jude Medical Masters prosthesis.
  • Evaluation of operative results and echocardiographic data up to 10 years post-surgery.
  • Analysis of reintervention rates, including explantation, pacemaker implantation, and leak repair.

Main Results:

  • One early cardiac death and one late non-cardiac death occurred in 17 infants.
  • Median follow-up was 9.6 years, with 11 patients requiring prosthetic valve explantation due to outgrowth at a median of 2.9 years.
  • Prosthetic valve gradients increased significantly from 5.0 mm Hg at discharge to 14.3 mm Hg at 5-year follow-up.

Conclusions:

  • Mitral valve replacement with the 15-mm prosthesis is a viable option for infants, including neonates.
  • Freedom from prosthesis replacement for outgrowth averages 3.5 years.
  • Thromboembolic complications were infrequent, suggesting a favorable safety profile regarding embolic events.

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