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Mechanical Mitral Valve Replacement in Patients Under 18 Years of Age

Akiko Yamagata1, Takeshi Shinkawa1, Akihisa Furuta1

  • 1Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.

World Journal for Pediatric & Congenital Heart Surgery
|July 3, 2026
PubMed

Insights

Pediatric mechanical mitral valve replacement (mMVR) offers satisfactory long-term survival. Valve choice and surgery year impact mortality, while younger age increases reoperation risk.

Area of Science:

  • Cardiology
  • Pediatric Cardiac Surgery
  • Biomaterials Science

Background:

  • Pediatric mechanical mitral valve replacement (mMVR) is a complex procedure with significant long-term risks, including complications and the need for lifelong anticoagulation.
  • Evaluating long-term outcomes and identifying risk factors for survival and reoperation in pediatric mMVR is crucial for improving patient management.

Purpose of the Study:

  • To assess the long-term outcomes of mechanical mitral valve replacement (mMVR) in patients under 18 years of age.
  • To identify risk factors associated with mortality and the need for reoperation after pediatric mMVR.

Main Methods:

  • Retrospective analysis of 118 pediatric patients (<18 years) who underwent mMVR between 1965 and 2024.
  • Kaplan-Meier analysis for survival; competing risk models for reoperation; Cox regression for risk factor identification.
  • Review of demographics, operative data, and clinical outcomes.

Main Results:

  • Overall survival at 30 years was 61.5%. Early mortality was 12%.
  • Non-bileaflet valve use (HR=2.46) and later surgery year (HR=1.03) predicted mortality.
  • 33 patients required 36 redo mMVRs; younger age (<10 years) at initial surgery predicted redo mMVR.

Conclusions:

  • Long-term survival after pediatric mechanical mitral valve replacement is acceptable.
  • Prosthesis type and surgical era influence mortality, while younger age at implantation increases reoperation risk.
  • Optimizing timing and prosthesis selection is key for better long-term results in pediatric mMVR.
Keywords:
congenital heart diseasecongenital mitral regurgitationcongenital mitral stenosismechanical mitral valve replacement

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