Long-Term Outcomes of Mitral Valve Replacement in Patients Weighing Less Than 10 Kg

Abstract Background: The outcomes of mitral valve replacement (MVR) in pediatrics especially in the patients weighing less than 10kg are not always favorable. This study aimed to measure long-term outcomes of MVR in our institution.Methods: Nine young children weighing less than 10 kg underwent MVR with mechanical prostheses from November 2006 to April 2019 were enrolled in this retrospectively study. Kaplan–Meier survival analysis was used for the prediction of freedom from death and adverse events. Chi-square test was performed to compare outcomes for patients based on the ratio of mechanical prosthesis and weight. 14 related literatures were also reviewed to support our study.Results: All patients received bileaflet mechanical prostheses. The surgical technique varied among the patients with prostheses implanted in the intra-annular (n = 5), supra-annular (n=1), or with a Dacron conduit segment in the supra-annular position(n = 3). The valve size/weight ratio ranged from 2.11 to 5.00. After a mean follow-up period of 80.67 ± 63.37 months, the survival rate was 66.67%. One (11.1%) patient underwent an immediate revision MVR after initial MVR for the periprosthetic leak. No patients required surgical reintervention for the development of left ventricular outflow tract obstruction or permanent pacemaker placement during long-term follow-up.Conclusions: The tailored surgical strategy utilized for MVR in infants resulted in reliable valve function and excellent survival. Although revision is inevitable due to somatic growth, the bileaflet mechanical prostheses displayed appropriate durability.

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Long-term outcomes of mitral valve replacement in patients weighing less than 10 kg

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01443-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Haoyong Yuan ◽

Zhongshi Wu ◽

Ting Lu ◽

Yilun Tang ◽

Jinlan Chen ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Weight Ratio ◽

Somatic Growth ◽

Long Term Outcomes ◽

Mechanical Prosthesis ◽

Mechanical Prostheses

Abstract Background The outcomes of mitral valve replacement (MVR) in pediatrics especially in the patients weighing less than 10 kg are not always favorable. This study aimed to measure long-term outcomes of MVR in our institution. Methods Nine young children weighing less than 10 kg underwent MVR with mechanical prostheses were enrolled in this retrospectively study. Kaplan–Meier survival analysis was used for the prediction of freedom from death and adverse events. Chi-square test was performed to compare outcomes for patients with different ratios of mechanical prosthesis size and body weight. Fourteen related literatures were also reviewed to support our study. Results All patients received bileaflet mechanical prostheses replacement. The surgical technique varied among the patients with prostheses implanted in the intra-annular (n = 5), supra-annular (n = 1), or with a Dacron conduit segment in the supra-annular position (n = 3). The valve size/weight ratio ranged from 2.11 to 5.00. There were two early death and one late death post-operation. The mean follow-up period was 80.67 ± 63.37 months, the transvalvular gradient was 10.5 ± 1.76 mmHg (range 8 to 12) and the peak gradient of LVOT was 5.00 ± 0.64 mmHg. One (11.1%) patient underwent an immediate revision MVR after initial MVR due to the periprosthetic leak. No patients required surgical reintervention or permanent pacemaker placement during long-term follow-up. Conclusions The tailored surgical strategy utilized for MVR in infants resulted in reliable valve function and excellent survival. Although revision is inevitable due to somatic growth, the bileaflet mechanical prostheses displayed appropriate durability.

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Long-term outcomes of mitral valve replacement in patients weighing less than 10 kg

10.21203/rs.3.rs-27771/v1 ◽

2020 ◽

Author(s):

Haoyong Yuan ◽

Zhongshi Wu ◽

Ting Lu ◽

Yilun Tang ◽

Jinlan Chen ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Surgical Techniques ◽

Weight Ratio ◽

Somatic Growth ◽

Left Ventricular ◽

Long Term Outcomes ◽

Mechanical Prostheses

Abstract Background: The techniques of mitral valve repair（MVP ) in children have been well established and provide acceptable long-term outcomes; certain pediatric patients require mitral valve replacement (MVR) after an unsuccessful MVP. The outcomes of MVR in pediatrict especially in the patients weighning are not always favorable. This study aimed to measure long-term outcomes of MVR at our institute.Methods: Nine young children weighing less than 10 kg underwent MVR from November 2006 to April 2019. Their mean age was 11.88 ± 11.29 months and mean body weight was 6.83 ± 2.56 kg at the time of initial MVR. Four patients (44.4%) had undergone at least one previous cardiac surgical procedure prior to MVR. Several surgical techniques were used to implant mechanical bileaflet prostheses.Results: All patients received bileaflet mechanical prostheses. The surgical technique varied among the patients with valves implanted intra-annularly (n = 5), supra-annularly (n=1), or supra-annularly with a tilt (n = 3). The valve size/weight ratio ranged from 2.11 to 5.00. After a mean follow-up period of 80.67 ± 63.37 months, the survival rate was 66.67%. One (11.1%) patient underwent an immediate revision MVR after initial MVR for the preprosthetic leak. No patients required surgical reintervention for the development of left ventricular outflow tract obstruction or permanent pacemaker placement during long-term follow-up.Conclusions: The tailored surgical strategy utilized for MVR in infants resulted in reliable valve function and excellent survival. Although revision is inevitable due to somatic growth, the bileaflet mechanical prostheses displayed appropriate durability.

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Patient-Specific Approach to Mitral Valve Replacement in Infants Weighing 10 kilograms or less

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119837200 ◽

2019 ◽

Vol 10 (3) ◽

pp. 304-312

Author(s):

Kathryn Mater ◽

Julian Ayer ◽

Ian Nicholson ◽

David Winlaw ◽

Richard Chard ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Surgical Techniques ◽

Somatic Growth ◽

Mechanical Valve ◽

Left Ventricular ◽

Patient Specific ◽

Mechanical Prostheses

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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Mitral Valve Replacement Using Mechanical Prostheses in Children: Early and Long-Term Outcomes

Pediatric Cardiology ◽

10.1007/s00246-012-0194-y ◽

2012 ◽

Vol 33 (4) ◽

pp. 639-645 ◽

Cited By ~ 7

Author(s):

Hyung-Tae Sim ◽

Seung-Cheol Lee ◽

Hong Ju Shin ◽

Jeong-Jun Park ◽

Tae-Jin Yun ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Long Term Outcomes ◽

Mechanical Prostheses

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Long-term outcomes after reoperation for mitral paravalvular leaks: a single-centre experience

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa331 ◽

2020 ◽

Author(s):

Shin Yajima ◽

Satsuki Fukushima ◽

Kizuku Yamashita ◽

Yusuke Shimahara ◽

Naoki Tadokoro ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Prosthetic Valve Endocarditis ◽

Paravalvular Leak ◽

Class Iii ◽

Long Term Outcomes ◽

Low Cardiac Output Syndrome

Abstract OBJECTIVES We aimed to analyse the pathology of paravalvular leak (PVL), and determine the long-term outcomes of redo mitral valve replacement and risk factors of all-cause mortality. METHODS Seventy-nine patients (mean age 70 ± 9 years; 54 female, 68%) who underwent redo mitral valve replacement for mitral PVL between January 2000 and May 2019 were retrospectively reviewed. Indications for PVL intervention were haemolytic anaemia (57/79, 72%), New York Heart Association class III/IV congestive heart failure (56/79, 71%) and prosthetic valve endocarditis with PVL (2/79, 3%). RESULTS PVL most commonly occurred at lateral sectors (42/79, 55%). Early mortality occurred in 2 patients (3%) due to low cardiac output syndrome. Two patients (3%) had residual PVL at discharge. Sixteen patients (23%) developed late PVL (mean follow-up, 3.4 ± 2.9 years), among whom 11 (69%) developed PVL at same area as that preoperatively. Additionally, 9 patients (56%) developed PVL at lateral sectors in late follow-up. At 1, 5 and 10 years, the survival rate was 93%, 72% and 45%; rate of freedom from cardiac death was 96%, 92% and 78%; and rate of freedom from PVL recurrence was 94%, 82% and 54%, respectively. Chronic kidney disease was the only risk factor in the multivariate analysis for mortality [P = 0.013; hazard ratio 4.0 (1.4–11.0)]. CONCLUSIONS Surgery for mitral PVL confers reasonable early and long-term outcomes. Greater attention to the anterolateral annulus may help prevent PVL.

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Pulmonary Autograft Mitral Valve Replacement (Ross II): Long-Term Follow-Up of a US Center

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118792196 ◽

2018 ◽

Vol 9 (6) ◽

pp. 645-650

Author(s):

David Blitzer ◽

Jeremy L. Herrmann ◽

John W. Brown

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Sudden Cardiac Arrest ◽

Right Heart Failure ◽

Atrioventricular Canal ◽

Pulmonary Autograft ◽

Atrioventricular Canal Defect

Background: Mitral valve replacement (MVR) with a pulmonary autograft (Ross II) may be a useful technique for pediatric and young adult patients who wish to avoid anticoagulation. Our aim was to evaluate the long-term outcomes of the Ross II procedure at our institution. Methods: Patients undergoing the Ross II procedure between June 2002 and April 2008 were included. Preoperative diagnoses included rheumatic disease (n = 5), congenital mitral valve (MV) pathology (partial atrioventricular canal defect [n = 2], complete atrioventricular canal defect [n = 1], Shone's complex [n = 1]), and myocarditis (n = 1). Results: Ten patients (eight females and two males) between 7 months and 46 years were included. Mean age at surgery was 25.2 ± 15.7 years. There were no in-hospital deaths. Mean follow-up was 11.7 ± 5.2 years. There were three late deaths at 11 months, 5 years, and 11 years, respectively. Causes of death included right heart failure, sepsis, and sudden cardiac arrest. Three patients required subsequent mechanical MVR a median of two years after the Ross II procedure (range: 1-4 years). There was no mortality with reoperation. Echocardiographic follow-up demonstrated mean MV gradients ranging from 2.2 to 9.6 mm Hg. Two patients had greater than mild MV regurgitation postoperatively, and all others had minimal mitral regurgitation or less. Two patients developed moderate MV stenosis. Conclusions: The Ross II procedure is an option for select older children and young adults desiring a durable tissue MVR to avoid long-term anticoagulation.

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