|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.|
|PMID: 18954636 Owner: NLM Status: MEDLINE|
|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.|
|Elif Seda Selamet Tierney; Frank A Pigula; Charles I Berul; James E Lock; Pedro J del Nido; Doff B McElhinney|
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|Type: Journal Article Date: 2008-08-03|
|Title: The Journal of thoracic and cardiovascular surgery Volume: 136 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2008 Oct|
|Created Date: 2008-10-28 Completed Date: 2008-12-30 Revised Date: -|
Medline Journal Info:
|Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States|
|Languages: eng Pagination: 954-61, 961.e1-3 Citation Subset: AIM; IM|
|Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA.|
|APA/MLA Format Download EndNote Download BibTex|
Heart Defects, Congenital / diagnosis, mortality, surgery*
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / adverse effects, methods*
Mitral Valve / abnormalities*
Mitral Valve Insufficiency / congenital, mortality, surgery*
Mitral Valve Stenosis / congenital, mortality, surgery*
Postoperative Complications / mortality
Proportional Hazards Models
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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