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Mitral valve replacement in children
Abstract:
Mitral valve replacement (MVR) is associated with higher mortality and morbidity rates in children than in adults, and the use of heterograft valves has been encouraged. The results of MVR in 56 consecutive patients, aged 2 to 12 years, presenting between January, 1972, and January 1979, were reviewed to test these beliefs. The etiology of mitral valve disease was rheumatic in 46, congenital in eight, and acute bacterial endocarditis in two. All children were seriously disabled (NYHA Classes III and IV). Cardiac catheterization in 36 patients revealed mixed valve disease in 26, pure mitral regurgitation in seven, and pure mitral stenosis in three. Seventeen Starr-Edwards (SE), five Lillehei (L), Björk-Shiley (BS), eight Hancock (H), and 25 Carpentier-Edwards (CE) mitral prosthesis were inserted. Operative mortality was 2% (1 BS) and late mortality was 10% (three SE, one L, two CE). Serious late complications occurred in 30% of survivors, including 11 instances of calcific valve stenosis (five H, six CE), one case of valve thrombosis (1 L), and two embolic episodes (1 SER, 1 H). Survival curves were similar for patients with heterograft and mechanical valves (92% and 77% at 5 years). Event-free curves showed heterograft valves to have a far higher complication rate than mechanical valves (10% complication free at 4 years compared to 84% free at 5 years). Early operative results in children are excellent, and the overall mortality (10%) compares favorably with figures for MVR in adults. However the long-term durability and choice of prostheses remain problematical, since less than 10% of heterograft valves survive beyond 5 years.
Insights
Mitral valve replacement in children shows excellent early results, but long-term durability of heterograft valves is a concern. Mechanical valves offer better event-free survival compared to bioprosthetic options.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Mitral valve replacement (MVR) in pediatric patients historically presents higher risks than in adults.
- Heterograft valves have been favored for pediatric MVR due to perceived lower risks.
- This study evaluates the outcomes of MVR in children using various prosthetic valves.
Purpose of the Study:
- To assess the early and late outcomes of mitral valve replacement in children.
- To compare the performance of mechanical versus heterograft prosthetic valves in pediatric patients.
- To evaluate the long-term durability and complication rates associated with different valve types.
Main Methods:
- Retrospective review of 56 pediatric patients (ages 2-12) undergoing MVR between 1972 and 1979.
- Analysis of valve etiology, NYHA functional class, and cardiac catheterization findings.
- Comparison of outcomes based on implanted prosthetic valve type: Starr-Edwards, Lillehei, Björk-Shiley, Hancock, and Carpentier-Edwards.
Main Results:
- Operative mortality was 2%, with overall late mortality at 10%.
- Serious late complications occurred in 30% of survivors, predominantly calcific stenosis in heterografts.
- Survival rates at 5 years were 92% for heterografts and 77% for mechanical valves.
- Event-free survival at 5 years was significantly higher for mechanical valves (84%) compared to heterografts (10%).
Conclusions:
- Early operative results for pediatric MVR are favorable, with overall mortality comparable to adult MVR.
- Long-term durability remains a significant issue, particularly for heterograft valves, with less than 10% surviving beyond 5 years.
- Mechanical valves demonstrate superior long-term event-free survival in pediatric mitral valve replacement compared to heterografts.