Document Detail


Mitral valve replacement in infants and children 5 years of age or younger: evolution in practice and outcome over three decades with a focus on supra-annular prosthesis implantation.
MedLine Citation:
PMID:  18954636     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Successful mitral valve replacement in young children is limited by the lack of small prosthetic valves. Supra-annular prosthesis implantation can facilitate mitral valve replacement with a larger prosthesis in children with a small annulus, but little is known about its effect on the outcomes of mitral valve replacement in young children.
METHODS: One hundred eighteen children underwent mitral valve replacement at 5 years of age or younger from 1976-2006. Mitral valve replacement was supra-annular in 37 (32%) patients.
RESULTS: Survival was 74% +/- 4% at 1 year and 56% +/- 5% at 10 years but improved over time (10-year survival of 83% +/- 7% from 1994-2006). Factors associated with worse survival included earlier mitral valve replacement date, age less than 1 year, complete atrioventricular canal, and additional procedures at mitral valve replacement, but not supra-annular mitral valve replacement. As survival improved during our more recent experience, the risks of supra-annular mitral valve replacement became apparent; survival was worse among patients with a supra-annular prosthesis after 1991. A pacemaker was placed in 18 (15%) patients within 1 month of mitral valve replacement and was less likely in patients who had undergone supra-annular mitral valve replacement. Among early survivors, freedom from redo mitral valve replacement was 72% +/- 5% at 5 years and 45% +/- 7% at 10 years. Twenty-one patients with a supra-annular prosthesis underwent redo mitral valve replacement. The second prosthesis was annular in 15 of these patients and upsized in all but 1, but 5 required pacemaker placement for heart block.
CONCLUSIONS: Supra-annular mitral valve replacement was associated with worse survival than annular mitral valve replacement in our recent experience. Patients with supra-annular mitral valve replacement were less likely to have operative complete heart block but remained at risk when the prosthesis was subsequently replaced.
Authors:
Elif Seda Selamet Tierney; Frank A Pigula; Charles I Berul; James E Lock; Pedro J del Nido; Doff B McElhinney
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Publication Detail:
Type:  Journal Article     Date:  2008-08-03
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  136     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-28     Completed Date:  2008-12-30     Revised Date:  2014-11-14    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  954-61, 961.e1-3     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Child, Preschool
Cohort Studies
Female
Follow-Up Studies
Heart Defects, Congenital / diagnosis,  mortality,  surgery*
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / adverse effects,  methods*
Humans
Infant
Infant, Newborn
Kaplan-Meier Estimate
Logistic Models
Male
Mitral Valve / abnormalities*
Mitral Valve Insufficiency / congenital,  mortality,  surgery*
Mitral Valve Stenosis / congenital,  mortality,  surgery*
Multivariate Analysis
Postoperative Complications / mortality
Probability
Proportional Hazards Models
Prosthesis Design
Registries
Retrospective Studies
Risk Assessment
Survival Rate
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
T32 HL007572/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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