HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Frank A. Pigula Pedro J. del Nido Doff B. McElhinney Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Selamet Tierney, E. S. Articles by McElhinney, D. B. Search for Related Content PubMed Articles by Selamet Tierney, E. S. Articles by McElhinney, D. B. Related Collections Congenital - acyanotic Valve disease

J Thorac Cardiovasc Surg 2008;136:954-961
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Mitral valve replacement in infants and children 5 years of age or younger: Evolution in practice and outcome over three decades with a focus on supra-annular prosthesis implantation

^a Department of Cardiology, Children's Hospital, Boston, Mass
^b Department of Cardiac Surgery, Children's Hospital, Boston, Mass
^c Department of Pediatrics, Harvard Medical School, Boston, Mass
^d Department of Surgery, Harvard Medical School, Boston, Mass

Received for publication October 19, 2007; revisions received December 11, 2007; accepted for publication December 14, 2007.

^_* Address for reprints: Doff B. McElhinney, MD, Department of Cardiology, Children's Hospital, 300 Longwood Ave, Boston, MA 02115. (Email: doff.mcelhinney{at}cardio.chboston.org).

Objective: Successful mitral valve replacement in young children is limited by the lack of small prosthetic valves. Supra-annular prosthesis implantation can facilitate mitral valve replacement with a larger prosthesis in children with a small annulus, but little is known about its effect on the outcomes of mitral valve replacement in young children.

Methods: One hundred eighteen children underwent mitral valve replacement at 5 years of age or younger from 1976–2006. Mitral valve replacement was supra-annular in 37 (32%) patients.

Results: Survival was 74% ± 4% at 1 year and 56% ± 5% at 10 years but improved over time (10-year survival of 83% ± 7% from 1994–2006). Factors associated with worse survival included earlier mitral valve replacement date, age less than 1 year, complete atrioventricular canal, and additional procedures at mitral valve replacement, but not supra-annular mitral valve replacement. As survival improved during our more recent experience, the risks of supra-annular mitral valve replacement became apparent; survival was worse among patients with a supra-annular prosthesis after 1991. A pacemaker was placed in 18 (15%) patients within 1 month of mitral valve replacement and was less likely in patients who had undergone supra-annular mitral valve replacement. Among early survivors, freedom from redo mitral valve replacement was 72% ± 5% at 5 years and 45% ± 7% at 10 years. Twenty-one patients with a supra-annular prosthesis underwent redo mitral valve replacement. The second prosthesis was annular in 15 of these patients and upsized in all but 1, but 5 required pacemaker placement for heart block.

Conclusions: Supra-annular mitral valve replacement was associated with worse survival than annular mitral valve replacement in our recent experience. Patients with supra-annular mitral valve replacement were less likely to have operative complete heart block but remained at risk when the prosthesis was subsequently replaced.

This article has been cited by other articles:

				J. W. Brown, A. C. Fiore, M. Ruzmetov, O. Eltayeb, M. D. Rodefeld, and M. W. Turrentine Evolution of Mitral Valve Replacement in Children: A 40-Year Experience Ann. Thorac. Surg., February 1, 2012; 93(2): 626 - 633. [Abstract] [Full Text] [PDF]

				K. R. Kanter, B. E. Kogon, and P. M. Kirshbom Supra-Annular Mitral Valve Replacement in Children Ann. Thorac. Surg., December 1, 2011; 92(6): 2221 - 2229. [Abstract] [Full Text] [PDF]

				D. Y. Rafii, R. R. Davies, S. J. Carroll, J. M. Quaegebeur, and J. M. Chen Age Less Than Two Years Is Not a Risk Factor for Mortality After Mitral Valve Replacement in Children Ann. Thorac. Surg., April 1, 2011; 91(4): 1228 - 1234. [Abstract] [Full Text] [PDF]

				G. Stellin, M. A. Padalino, V. L. Vida, G. Boccuzzo, E. Orru, R. Biffanti, O. Milanesi, and A. Mazzucco Surgical repair of congenital mitral valve malformations in infancy and childhood: A single-center 36-year experience J. Thorac. Cardiovasc. Surg., December 1, 2010; 140(6): 1238 - 1244. [Abstract] [Full Text] [PDF]

				R. Henaine, J. Nloga, F. Wautot, N. Yoshimura, M. Rabilloud, J.-F. Obadia, S. Di-Filippo, and J. Ninet Long-Term Outcome After Annular Mechanical Mitral Valve Replacement in Children Aged Less Than Five Years Ann. Thorac. Surg., November 1, 2010; 90(5): 1570 - 1576. [Abstract] [Full Text] [PDF]

				L. Deorsola, E. Chiappa, G. Agnoletti, and P. A. Abbruzzese Rescue mitral valve repair one hour after birth Interact CardioVasc Thorac Surg, November 1, 2010; 11(5): 716 - 718. [Abstract] [Full Text] [PDF]

				C. Lee, C.-H. Lee, J. G. Kwak, C. S. Park, S.-J. Kim, J. Y. Song, and W.-S. Shim Long-term results after mitral valve repair in children Eur J Cardiothorac Surg, February 1, 2010; 37(2): 267 - 272. [Abstract] [Full Text] [PDF]