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Predictors of survival in paediatric mitral valve replacement

Gianluca Brancaccio1, Matteo Trezzi1, Marcello Chinali2

  • 1Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|February 14, 2021
PubMed

Insights

Mitral valve replacement (MVR) in children is effective, with mortality predicted by prosthesis size/weight ratio and age under 2 years. Re-replacement is feasible, allowing for larger valve implantation.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Surgery
  • Biomedical Engineering

Background:

  • Congenital or acquired mitral valve disease in children often necessitates surgical intervention.
  • Mitral valve replacement (MVR) is a critical procedure for managing unrepairable mitral valve disease in pediatric patients.
  • Predicting outcomes and identifying risk factors for MVR in children is essential for optimizing patient care.

Purpose of the Study:

  • To identify predictors of mortality and reintervention following MVR in pediatric patients.
  • To assess the long-term efficacy and safety of MVR in children.
  • To evaluate the feasibility of mitral valve re-replacement in pediatric cases.

Main Methods:

  • A retrospective single-center study included 115 pediatric patients (<18 years) who underwent MVR between 1982 and 2019.
  • Calculated the ratio of prosthetic valve size to patient weight (mm/kg) at surgery.
  • Assessed long-term outcomes including freedom from re-replacement and death/transplant-free survival.

Main Results:

  • Death/transplant-free survival was 77±4% at 5 years and 72±5% at 10 years.
  • A size/weight ratio >2 and age <2 years were significant risk factors for death or transplant.
  • Biological prosthesis and a size/weight ratio >2 predicted reoperation; significant prosthesis upsizing was noted at re-replacement.

Conclusions:

  • Mitral valve replacement is a viable strategy for children with severe mitral valve disease.
  • Prosthesis size/weight ratio and early childhood age (<2 years) are key predictors of mortality after MVR.
  • Mitral valve re-replacement in children can be performed with acceptable morbidity and mortality, often accommodating larger prostheses.
Abstract

Keywords:
Mechanical valveMitral valve anomalies in childrenMitral valve replacementValve prosthesis

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