Clinical outcomes of mitral valve replacement with the 16-mm ATS advanced performance valve in neonates and infants.

Abstract

BACKGROUND:

Although mitral valve repair is the preferred treatment for mitral regurgitation in neonates and infants, mitral valve replacement (MVR) is sometimes necessary.

METHODS:

From 1999 through 2013, 18 patients younger than 1 year underwent MVR with the smallest (16 mm) commercially available mechanical valve. At surgery, mean age was 4.0 ± 1.8 months (range, 4 days to 7 months), and mean body weight was 5.3 ± 1.6 kg (range, 3.2 to 8.3 kg). Prosthetic valves were implanted in the supra-annular position in 17 of the 18 patients.

RESULTS:

All patients were followed up, and the mean follow-up period was 4.5 ± 3.8 years (range, 0.2 to 14 years). The rates of overall survival and freedom from redo MVR at 10 years were 88.9% and 57.8%, respectively. The causes of redo MVR were pulmonary hypertension in patients with left ventricular outflow obstruction (n = 2), hemolysis (n = 1), and a stuck valve (n = 1). The estimated effective orifice area index (effective orifice area/body surface area) was significantly inversely correlated with peak transmitral pressure gradient (r = -0.784, p < 0.01). The rate of freedom from permanent pacemaker implantation at 10 years was 71.2%. Three of the 5 pacemaker implantation procedures were for postoperative sick sinus syndrome. Although intracranial hemorrhage developed in 3 infants, all neurologic sequelae resolved.

CONCLUSIONS:

The implanted valves were durable, and no premature increase in transmitral pressure gradient was observed. Complications included injury of the sinus node artery and hemorrhage related to anticoagulation therapy.

• Authors: Jiyong Moon, Takaya Hoashi, Koji Kagisaki, Kenichi Kurosaki, Isao Shiraishi, Hajime Ichikawa
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 99 Issue 2 Pg. 653-9 (Feb 2015) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 25534529 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Female
• Heart Valve Prosthesis
• Humans
• Infant
• Infant, Newborn
• Male
• Mitral Valve (surgery)
• Mitral Valve Insufficiency (surgery)
• Prosthesis Design
• Retrospective Studies
• Treatment Outcome