Outcomes of Mechanical Mitral Valve Replacement in Children

• Type of Material: Article
• Authors: Chizitam Ibezim, University of Missouri; Amber Leila Sarvestani, University of Missouri; Jessica H. Knight, University of Missouri; Omar Qayum, University of Missouri; Noor Alshami, University of Missouri; Elizabeth Turk, Children's Mercy Hospital; James St Louis, Children's Mercy Hospital; Courtney McCracken, Emory University; James H. Moller, University of Minnesota; Lazaros Kochilas, Emory University; Geetha Raghuveer, Children's Mercy Hospital
• Language: English
• Date: 2019-01-01
• Publisher: Elsevier Science Ltd.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 by The Society of Thoracic Surgeons Published by Elsevier.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.athoracsur.2018.07.069
• Title of Journal or Parent Work: Annals of Thoracic Surgery
• Volume: 107
• Issue: 1
• Start Page: 143
• End Page: 150
• Grant/Funding Information: None declared
• Keywords: Respiratory System; Prosthesis; Science & Technology; Life Sciences & Biomedicine; Cardiovascular System & Cardiology; Mortality; Survival; Cardiac & Cardiovascular Systems; Surgery; Evolution
• Research Categories: Health Sciences, Human Development; Engineering, Biomedical; Health Sciences, Medicine and Surgery

Abstract

Background: Mitral valve anomalies in children are rare but frequently severe, recalcitrant and not often amenable to primary repair, necessitating mechanical mitral valve replacement (M-MVR). This study examines outcomes of a cohort undergoing 1st M-MVR at <21 years of age. Methods: We queried the Pediatric Cardiac Care Consortium (PCCC), a multi-institutional US-based cardiac intervention registry, for patients undergoing 1st M-MVR for two-ventricle congenital heart disease. Survival and transplant status through 2014 were obtained from PCCC and linkage with the National Death Index and the Organ Procurement and Transplantation Network. Results: We identified 441 patients [median age 4.3 years (IQR: 1.3-10.1)] meeting study criteria. The commonest disease necessitating M-MVR was atrioventricular canal (44.3%). Early mortality (death <90 days post-M-MVR) was 11.1%; there was increased risk of early death if age at M-MVR was <2 years (OR 7.8; 95% CI:1.1-56.6) and with concurrent other mechanical valve placement (OR 8.5; 95% CI:2.0-35.6). In those surviving >90 days post-M-MVR, transplant-free survival was 76% at 20 years follow-up (median follow-up: 16.6, IQR: 11.9-21.3). Adjusted analysis in those who survived >90 days showed elevated risk of death/transplant for males (HR 1.5; 95% CI:1.0-2.3), age at M-MVR <2 years [10 year survival, HR 4.3 (95%CI: 1.2 - 15.1)], and non-bi-leaflet prosthesis placement (HR 2.4; 95% CI: 1.3-4.3). Conclusions: M-MVR is a viable strategy in children with unrepairable mitral valve disease. Age <2 years at 1st M-MVR is associated with significant early risk of death and poorer longterm survival.