Background:
Despite the improvement of surgical techniques for mitral valve (MV) repair in children, mitral valve replacement (MVR) is sometimes still necessary. MVR and redo-MVR continue to be burdened by early postoperative mortality and long-term morbidity with only about 75% of these patients being alive or transplant-free 10 years after the initial MVR. Although transcatheter MVR (TMVR) is a well-established intervention in high surgical risk adults, only a few pediatric valve-in-valve case reports have been published. The purpose of this study was to describe our initial experience with the off-label use of the Sapien S3 valve for TMVR in a highly selected pediatric patient population.
Methods:
We conducted a retrospective analysis of pediatric patients who underwent TMVR at Boston Children’s Hospital between October 2018 and July 2020.
Results:
Eight consecutive high surgical risk pediatric patients (median age, 9 years; range, 8–15) underwent TMVR (7 as valve-in-valve, 1 in a native MV). Each patient previously underwent multiple MV surgeries or MVR (median 4, range 2–5) and was highly symptomatic (Ross functional class 3 or 4). The indication for TMVR was mitral stenosis in 4 patients, regurgitation in 1, and mixed disease in 3. TMVR was successful in each patient, effectively reduced the left atrium and pulmonary hypertension (
P
=0.012 and 0.043 respectively), and was carried out without significant complications.
Conclusions:
TMVR is an attractive alternative to MVR in high surgical risk patients. In this small series, TMVR was acutely effective and safe, with very encouraging early results.
Transcatheter “valve‐in‐valve” mitral valve replacement for patient‐prosthesis mismatch: Chronicle of a death foretold