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Mechanical Mitral Valve Replacements in the Pediatric Population.
Christopher Ibarra1, Zachary Spigel1, Rija John1
1Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
The Annals of Thoracic Surgery
|September 4, 2020
Summary
Optimizing prosthetic mitral valve replacement in children involves selecting a valve size-to-weight ratio between 1 and 2. This ratio enhances valve survival and reduces reoperation rates in pediatric patients weighing up to 35 kg.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Surgical Outcomes
Background:
- Prosthetic valve selection is critical for optimizing outcomes in pediatric patients.
- The size-to-weight ratio of prosthetic valves is a key factor in ensuring long-term valve survival.
- Small children present unique challenges for prosthetic valve fitting and performance.
Purpose of the Study:
- To evaluate the optimal prosthetic size-to-weight ratio for mechanical mitral valve replacements in pediatric patients.
- To determine the relationship between size-to-weight ratio and valve survival or reoperation rates.
- To identify specific size-to-weight ratio ranges associated with improved outcomes in children.
Main Methods:
- Retrospective review of mechanical mitral valve replacements in children weighing ≤35 kg from 1995-2019.
- Calculation of prosthetic valve size-to-weight ratio (valve diameter/patient weight).
- Analysis of patient death and reoperation rates based on the size-to-weight ratio, identifying a U-shaped distribution.
Main Results:
- Mechanical mitral valve replacements were performed in 56 children (75%) weighing ≤35 kg.
- A size-to-weight ratio between 1 and 2 was associated with the nadir of adverse events.
- Five-year reoperation-free survival was 96% for ratios of 1-2, compared to 46% for ratios outside this range (P < .001).
Conclusions:
- Optimal reoperation-free survival after mitral valve replacement in children ≤35 kg is achieved with a size-to-weight ratio of 1-2.
- This size-to-weight ratio range provides superior outcomes regardless of patient age.
- Prosthetic valve sizing based on the size-to-weight ratio is crucial for pediatric mitral valve surgery.
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