Faculty Collaboration Database

Mitral valve replacement in children: predictors of long-term outcome. Ann Thorac Surg 2003 Sep;76(3):853-9; discussion 859-60

Date

09/10/2003

Pubmed ID

12963215

DOI

10.1016/s0003-4975(03)00661-1

Scopus ID

2-s2.0-0042331599 (requires institutional sign-in at Scopus site)   53 Citations

Abstract

BACKGROUND: Mitral valve replacement (MVR) in children has been associated with a high complication rate. We sought to assess predictors of outcomes in children undergoing MVR.

METHODS: A retrospective review of clinical, surgical, and echocardiographic records of patients undergoing MVR was performed. Between 1982 and 2000, 53 children underwent 76 MVR procedures at a median age of 5 years (range, 1 day to 18 years) and weight of 17 kg (range, 3 to 121 kg). Eighteen patients (34%) had more than one MVR. Previous cardiac surgery had been performed in 39 (74%), with 27 (51%) undergoing previous mitral repair. Patients were followed for 9.2 +/- 4.8 (range, 2 to 20) years.

RESULTS: There were 14 patient deaths, with 6 patients dying within 30 days, and five transplants (36%). Ten-year freedom from reoperation was 66%. Long-term survivors were older at initial repair (7.0 vs 2.5 years, p = 0.02), with a lower incidence of residual cardiac lesions (3% vs 37%, p < 0.001) and a lower incidence of surgical procedures at the time of MVR (31% vs 63%, p = 0.04). Survivors had better left ventricular function preoperatively (ejection fraction, 68% vs 54%; p = 0.001) and placement of a prosthetic valve within 1 z-score of the echocardiographically measured mitral valve annulus (p = 0.02).

CONCLUSIONS: Adverse outcome after MVR is common, particularly in the young child undergoing palliative surgery or requiring additional surgical procedures. Preoperative assessment of mitral valve size and ventricular function is essential for risk stratification of these patients.

Author List

Eble BK, Fiser WP, Simpson P, Dugan J, Drummond-Webb JJ, Yetman AT

Author

Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Female
Follow-Up Studies
Heart Valve Diseases
Humans
Infant
Infant, Newborn
Male
Mitral Valve
Prognosis
Retrospective Studies
Survival Rate
Time Factors
Treatment Outcome
Ultrasonography