Mitral Valve Replacement With the 15-mm Mechanical Valve: A 20-Year Multicenter Experience

Background: Mitral valve replacement (MVR) is the only option for infants with severe mitral valve disease that is not reparable; however, previously reported outcomes are not always favorable. Our institution has followed a tailored approach to sizing and positioning of mechanical valve prostheses in infants requiring MVR in order to obtain optimal outcomes. Methods: Outcomes for 22 infants ≤10 kg who have undergone MVR in Sydney, Australia, from 1998 to 2016, were analyzed. Patients were at a mean age of 6.8 ± 4.1 months (range: 0.8-13.2 months) and a mean weight of 5.4 ± 1.8 kg at the time of MVR. Most patients (81.8%) had undergone at least one previous cardiac surgical procedure prior to MVR, and 36.4% had undergone two previous procedures. Several surgical techniques were used to implant mechanical bileaflet prostheses. Results: All patients received bileaflet mechanical prostheses, with 12 receiving mitral prostheses and 10 receiving inverted aortic prostheses. Surgical technique varied between patients with valves implanted intra-annularly (n = 6), supra-annularly (n = 11), or supra-annularly with a tilt (n = 5). After a mean follow-up period of 6.2 ± 4.4 years, the survival rate was 100%. Six (27.3%) patients underwent redo MVR a mean of 102.2 ± 10.7 months after initial MVR. Four (18.2%) patients required surgical reintervention for development of left ventricular outflow tract obstruction and three (13.6%) patients required permanent pacemaker placement during long-term follow-up. Conclusions: The tailored surgical strategy utilized for MVR in infants at our institution has resulted in reliable valve function and excellent survival. Although redo is inevitable due to somatic growth, the bileaflet mechanical prostheses used displayed appropriate durability.

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Valvular heart diseases. (1). Results of mitral valve replacement with mechanical valve prosthesis. Comparative study of Bjoerk-Shiley convexo-concave valve, duromedics valve and Medtronic-Hall valve.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.19.684 ◽

1990 ◽

Vol 19 (4) ◽

pp. 684-685

Author(s):

H. Kanda

Keyword(s):

Mitral Valve ◽

Comparative Study ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Diseases ◽

Mechanical Valve ◽

Valve Prosthesis ◽

Valvular Heart Diseases

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Use of an On-X Prosthetic Valve In A 42-Year Old Female With Antiphospholipid Syndrome

The Heart Surgery Forum ◽

10.1532/hsf.1805 ◽

2018 ◽

Vol 21 (1) ◽

pp. 026

Author(s):

Ayumi Koga ◽

Ken Okamoto ◽

Hirokazu Tazume ◽

Toshihiro Fukui

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Antiphospholipid Syndrome ◽

Antiphospholipid Antibodies ◽

Therapeutic Option ◽

Mechanical Valve ◽

Young Female ◽

Valve Function ◽

Anticoagulation Intensity

Antiphospholipid syndrome is a rare autoimmune disease with a hypercoagulable state causing vascular thrombosis. We present the case of a 42-year old female who underwent mitral valve replacement with a mechanical valve 15 months ago. The postoperative course was uneventful, and echocardiography performed 14 months postoperatively showed good valve function. The patient developed sudden dyspnea 15 months postoperatively and was referred to our hospital. Echocardiography revealed mitral stenosis with stuck leaflets. Emergent re-mitral valve replacement was successfully performed using an On-X valve (On-X Life Technologies, Austin, TX, USA). The patient tested positive for antiphospholipid antibodies. Antiphospholipid syndrome should be considered when valve dysfunction occurs suddenly in relatively young female patients. The On-X valve may be considered as a therapeutic option in patients with antiphospholipid syndrome because of its low anticoagulation intensity.

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Supra-Annular Mitral Valve Replacement in Infants with Congenital Mitral Valve Disease

The Heart Surgery Forum ◽

10.1532/hsf.2593 ◽

2019 ◽

Vol 22 (5) ◽

pp. E315-E316

Author(s):

Haoyong Yuan ◽

Zhongshi Wu ◽

Yifeng Yang ◽

Can Huang

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Early Death ◽

Mechanical Valve ◽

Ptfe Graft ◽

Prosthetic Valves ◽

Mechanical Valves ◽

Neonates And Infants

Mitral valve replacement in infants is rare and causes a relatively high mortality, especially for patients under the age of 1. Supra-annular valve replacement is a viable technique for infants with a small valve annulus. Here, we report two infants who underwent mitral valve replacement via the supra-annular technique. The age and body weight of these babies were 2 months and 3 months and 4.1 kg and 4.7 kg, respectively. Aortic mechanical valves were reversely implanted with a short segment of PTFE graft. The purpose of this strategy was to insert a larger mechanical valve and delay resternotomy. A two-year follow-up exam showed normal ventricular function without mechanical valve-related complications. This method is useful in treating neonates and infants. Although the technique of mitral valve repair has improved over several decades, mitral valve replacement still is necessary at times. In neonates and infants with a small annulus, implantation of commercially available prosthetic valves in the annular position can be a challenge, and an age less than 1 year is a risk factor for early death [Selamet 2008]. Supra-annular mitral valve replacement (SMVR) is an alternative when a traditional annular implantation is not feasible [Sung 2008]. Herein, we report the cases of two patients, who underwent SMVR with a follow-up after two years.

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Redo mitral valve surgery

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v11i1.35583 ◽

2018 ◽

Vol 11 (1) ◽

pp. 89

Author(s):

Redoy Ranjan ◽

Mushfiqur Rahman ◽

Heemel Saha ◽

Dipannita Adhikary ◽

Sanjoy Kumar Saha ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Color Doppler ◽

Systolic Pressure ◽

Mechanical Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Pulmonary Artery Systolic Pressure ◽

Female Ratio

<p class="Abstract">This study is based on the findings of a single surgeon’s practice of mitral valve replacement of 167 patients from April 2005 to June 2017 who developed symptomatic mitral restenosis after closed or open mitral commisurotomy. Both clinical and color doppler echocardiographic data of peri-operative and six months follow-up period were evaluated and compared to assess the early outcome of the redo mitral valve surgery. With male-female ratio of 1: 2.2 and after a duration of 6 to 22 years symptom free interval between the redo procedures, the selected patients with mitral valve restenosis undergone valve replacement with either mechanical valve in 62% cases and also tissue valve in 38% cases. Particular emphasis was given to separate the adhered pericardium from the heart completely to ameliorate base to apex and global contraction of the heart. Besides favorable post-operative clinical outcome, the echocardiographic findings were also encouraging as there was statistically significant increase in the mitral valve area and ejection fraction with significant decrease in the left atrial diameter, pressure gradient across the mitral valve and pulmonary artery systolic pressure. Therefore, in case of inevitable mitral restenosis after closed or open commisurotomy, mitral valve replacement is a promising treatment modality.</p>

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Left ventricular pseudoaneurysm following atrioventricular groove rupture after mitral valve replacement

SAGE Open Medical Case Reports ◽

10.1177/2050313x18823456 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1882345

Author(s):

Miha Antonic ◽

Anze Djordjevic ◽

Tamara Mohorko ◽

Rene Petrovic ◽

Robert Lipovec ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Unusual Case ◽

Mechanical Valve ◽

Left Ventricular ◽

Valve Surgery ◽

Pericardial Patch ◽

Left Ventricular Pseudoaneurysm ◽

Atrioventricular Groove

Left ventricular pseudoaneurysm is a partial cardiac rupture, contained by the surrounding pericardium that maintains communication with the left ventricular lumen. Whereas most cases of left ventricular pseudoaneurysms are related to myocardial infarction (loss of myocardial integrity), only a handful are associated with valve surgery. We present a female patient, who was admitted for elective mitral valve replacement. After the implantation of the mechanical valve, we encountered a rupture of the atrioventricular groove. After 3 months, a left ventricular pseudoaneurysm was found and the patient was reoperated. The valve was explanted and the inspection of the annulus and previously implanted pericardial patch revealed a loosened stitch on the inferior (ventricular) side. The defect was reinforced with additional stitches and the valve was reimplanted. In conclusion, we report an unusual case with two serious complications after mitral valve replacement – atrioventricular groove rupture and left ventricular pseudoaneurysm.

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Abstract 15993: Survival Benefit of Mechanical Valve Over Biological Valve for Isolated Mitral Valve Replacement in Young Dialysis Patients: National Database Analysis

Circulation ◽

10.1161/circ.142.suppl_3.15993 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Takuya Ogami ◽

Dimitrios V Avgerinos ◽

Eric Zimmermann ◽

Yuming Ning ◽

Paul Kurlansky ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Survival Benefit ◽

Mechanical Valve ◽

The United States ◽

National Database ◽

Dialysis Patients ◽

Term Survival ◽

Biological Valve

Introduction: Optimal valve choice for mitral valve replacement (MVR) in dialysis patients remains unclear. Hypothesis: Mechanical valve (MV) provides survival benefit over biological valve (BV) in young dialysis patients who are undergoing MVR. Methods: Using the United States Renal Data System, a total of 2,905 patients were found to have undergone isolated MVR from 2000 through 2015. Median follow up period was 1.27 years (IQR: 0.23-3.33). We stratified patients into 3 groups by age, and adjusted baseline characteristics between patients who received BV and MV using propensity score matching in each age group: Group1, 18 to 49 (n=456); Group2, 50 to 69 (n=1030); and Group3, 70 or older (n=338). Primary endpoint was 10-year mortality. Cox-hazard model was used to compare 10-year mortality between BV and MV in matched cohorts. Results: Overall in-hospital and 10-year mortality rates were 16.8% and 87.1%, respectively. Use of BV increased from 17.8% in 2000 to 47.2% in 2015 (Figure 1). In the propensity matched groups, Cox hazard analysis revealed BV was independently associated with higher risk of mortality in Group1 (HR 1.51, 95% CI 1.22-1.86, P<0.001), but not for Group 2 (HR 1.01, 95% CI 0.88-1.15, P=0.88) or Group 3 (HR 0.9, 95% CI 0.72-1.13, P=0.37) (Figure 2). Conclusions: MV is associated with better long-term survival over BV in well-matched young dialysis patients who are undergoing isolated MVR.

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Mitral Valve Replacement with a Mechanical Valve for Severe Mitral Regurgitation in a Small Dog

Case Reports in Veterinary Medicine ◽

10.1155/2014/892625 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5

Author(s):

Daisuke Taguchi ◽

Isamu Kanemoto ◽

Satoko Yokoyama ◽

Masashi Mizuno ◽

Makoto Washizu

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Warfarin Therapy ◽

Mechanical Valve ◽

Severe Mitral Regurgitation ◽

Mitral Valve Plasty ◽

Class D

A seven-year-old Shih Tzu with refractory repeated pulmonary edema and syncope was presented for surgical operation. From the results of cardiovascular examinations, the dog was diagnosed as severe mitral regurgitation (ACVIM consensus class D) and mild tricuspid regurgitation. The dog first underwent surgery with mitral valve plasty; however, the results were unsatisfactory due to severe damage of the whole mitral valve. The operation was quickly changed to mitral valve replacement using a mechanical valve (19 mm). The dog survived surgery and lived for 2 years and one month after operation using long-term anticoagulant (warfarin) therapy in spite of several thrombosis-related events.

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Mitral Valve Replacement in Infants Using a 15-mm Mechanical Valve

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2019.02.061 ◽

2019 ◽

Vol 108 (2) ◽

pp. 552-557 ◽

Cited By ~ 7

Author(s):

Osama M. Eltayeb ◽

William J. Readdy ◽

Michael C. Mongé ◽

Joseph M. Forbess ◽

Anne E. Sarwark ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mechanical Valve

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Acute Thrombotic Obstruction of Mitral Valve Prosthesis: Low Protein C Level

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230201000218 ◽

2002 ◽

Vol 10 (2) ◽

pp. 165-166 ◽

Cited By ~ 1

Author(s):

Toshihiro Ohata ◽

Tetsuo Sakakibara ◽

Hiroshi Takano ◽

Toru Ishizaka

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Protein C ◽

Mechanical Valve ◽

Protein S ◽

Valve Prosthesis ◽

Normal Value ◽

Low Protein ◽

Mitral Valve Prosthesis

A 51-year-old female underwent redo mitral valve replacement with a pericardial bioprosthesis because of acute thrombotic obstruction of a mechanical valve, in spite of adequate anticoagulation with warfarin. Her protein C level was 24% of the normal value and protein S was reduced to 54% of normal.

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