Mitral Valve Replacement in Infants using a 15-mm Mechanical Valve

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Abstract

BACKGROUND: The 15-mm mechanical valve was approved by the FDA in March 2018. We review our experience for infants with this valve in the mitral position, focusing on outcomes and timing to repeat mitral valve replacement (MVR).

METHODS: Between 2006-2017, 7 patients underwent 8 MVRs (1 repeat) with a 15-mm mechanical valve. Retrospective chart review was performed to examine short- and long-term outcomes.

RESULTS: There was no operative mortality. Mean follow-up was 5.8±4.8 years (range 0.72-11.1 years). Six patients underwent a MV operation 53±39 (9-118) days prior to 15-mm MVR. All patients were on mechanical ventilatory support at time of 15-mm MVR. Mean age, body weight, and BSA at time of 15-mm MVR were 0.5±0.3 (0.2-0.9) years, 5.6±0.8 (4.8-6.6) kg and 0.29±0.03 (0.27-0.32) m2, respectively. Two patients required pacemaker implantation for AV block, both after their second MVR. Two patients are well at 16 and 24 months. Four patients underwent repeat MVR due to somatic growth and patient-prosthesis mismatch. Mean time to repeat MVR was 23 months (range 6-40 months). There were 2 late deaths, one at 10 months unrelated to the valve in a child with a chromosomal abnormality. The other child had a congenital diaphragmatic hernia, early valve thrombosis, and died of multiple complications after a 4th MVR.

CONCLUSIONS: The 15-mm MV was useful in treating MV disease in infants 2-12 months of age. This newly approved smallest available mechanical valve has a predicted mean time to replacement of 23 months in the mitral position.

Original languageEnglish (US)
JournalThe Annals of thoracic surgery
DOIs
StateE-pub ahead of print - Mar 27 2019

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Mitral Valve
Atrioventricular Block
Chromosome Aberrations
Prostheses and Implants
Thrombosis
Body Weight
Mortality
Growth

Cite this

@article{2cfc9c046e734819b203f31d915fbff1,
title = "Mitral Valve Replacement in Infants using a 15-mm Mechanical Valve",
abstract = "BACKGROUND: The 15-mm mechanical valve was approved by the FDA in March 2018. We review our experience for infants with this valve in the mitral position, focusing on outcomes and timing to repeat mitral valve replacement (MVR).METHODS: Between 2006-2017, 7 patients underwent 8 MVRs (1 repeat) with a 15-mm mechanical valve. Retrospective chart review was performed to examine short- and long-term outcomes.RESULTS: There was no operative mortality. Mean follow-up was 5.8±4.8 years (range 0.72-11.1 years). Six patients underwent a MV operation 53±39 (9-118) days prior to 15-mm MVR. All patients were on mechanical ventilatory support at time of 15-mm MVR. Mean age, body weight, and BSA at time of 15-mm MVR were 0.5±0.3 (0.2-0.9) years, 5.6±0.8 (4.8-6.6) kg and 0.29±0.03 (0.27-0.32) m2, respectively. Two patients required pacemaker implantation for AV block, both after their second MVR. Two patients are well at 16 and 24 months. Four patients underwent repeat MVR due to somatic growth and patient-prosthesis mismatch. Mean time to repeat MVR was 23 months (range 6-40 months). There were 2 late deaths, one at 10 months unrelated to the valve in a child with a chromosomal abnormality. The other child had a congenital diaphragmatic hernia, early valve thrombosis, and died of multiple complications after a 4th MVR.CONCLUSIONS: The 15-mm MV was useful in treating MV disease in infants 2-12 months of age. This newly approved smallest available mechanical valve has a predicted mean time to replacement of 23 months in the mitral position.",
author = "Eltayeb, {Osama M} and Readdy, {William J} and Mong{\'e}, {Michael C} and Forbess, {Joseph M} and Sarwark, {Anne E} and Angira Patel and Backer, {Carl L}",
note = "Copyright {\circledC} 2019. Published by Elsevier Inc.",
year = "2019",
month = "3",
day = "27",
doi = "10.1016/j.athoracsur.2019.02.061",
language = "English (US)",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Mitral Valve Replacement in Infants using a 15-mm Mechanical Valve

AU - Eltayeb, Osama M

AU - Readdy, William J

AU - Mongé, Michael C

AU - Forbess, Joseph M

AU - Sarwark, Anne E

AU - Patel, Angira

AU - Backer, Carl L

N1 - Copyright © 2019. Published by Elsevier Inc.

PY - 2019/3/27

Y1 - 2019/3/27

N2 - BACKGROUND: The 15-mm mechanical valve was approved by the FDA in March 2018. We review our experience for infants with this valve in the mitral position, focusing on outcomes and timing to repeat mitral valve replacement (MVR).METHODS: Between 2006-2017, 7 patients underwent 8 MVRs (1 repeat) with a 15-mm mechanical valve. Retrospective chart review was performed to examine short- and long-term outcomes.RESULTS: There was no operative mortality. Mean follow-up was 5.8±4.8 years (range 0.72-11.1 years). Six patients underwent a MV operation 53±39 (9-118) days prior to 15-mm MVR. All patients were on mechanical ventilatory support at time of 15-mm MVR. Mean age, body weight, and BSA at time of 15-mm MVR were 0.5±0.3 (0.2-0.9) years, 5.6±0.8 (4.8-6.6) kg and 0.29±0.03 (0.27-0.32) m2, respectively. Two patients required pacemaker implantation for AV block, both after their second MVR. Two patients are well at 16 and 24 months. Four patients underwent repeat MVR due to somatic growth and patient-prosthesis mismatch. Mean time to repeat MVR was 23 months (range 6-40 months). There were 2 late deaths, one at 10 months unrelated to the valve in a child with a chromosomal abnormality. The other child had a congenital diaphragmatic hernia, early valve thrombosis, and died of multiple complications after a 4th MVR.CONCLUSIONS: The 15-mm MV was useful in treating MV disease in infants 2-12 months of age. This newly approved smallest available mechanical valve has a predicted mean time to replacement of 23 months in the mitral position.

AB - BACKGROUND: The 15-mm mechanical valve was approved by the FDA in March 2018. We review our experience for infants with this valve in the mitral position, focusing on outcomes and timing to repeat mitral valve replacement (MVR).METHODS: Between 2006-2017, 7 patients underwent 8 MVRs (1 repeat) with a 15-mm mechanical valve. Retrospective chart review was performed to examine short- and long-term outcomes.RESULTS: There was no operative mortality. Mean follow-up was 5.8±4.8 years (range 0.72-11.1 years). Six patients underwent a MV operation 53±39 (9-118) days prior to 15-mm MVR. All patients were on mechanical ventilatory support at time of 15-mm MVR. Mean age, body weight, and BSA at time of 15-mm MVR were 0.5±0.3 (0.2-0.9) years, 5.6±0.8 (4.8-6.6) kg and 0.29±0.03 (0.27-0.32) m2, respectively. Two patients required pacemaker implantation for AV block, both after their second MVR. Two patients are well at 16 and 24 months. Four patients underwent repeat MVR due to somatic growth and patient-prosthesis mismatch. Mean time to repeat MVR was 23 months (range 6-40 months). There were 2 late deaths, one at 10 months unrelated to the valve in a child with a chromosomal abnormality. The other child had a congenital diaphragmatic hernia, early valve thrombosis, and died of multiple complications after a 4th MVR.CONCLUSIONS: The 15-mm MV was useful in treating MV disease in infants 2-12 months of age. This newly approved smallest available mechanical valve has a predicted mean time to replacement of 23 months in the mitral position.

U2 - 10.1016/j.athoracsur.2019.02.061

DO - 10.1016/j.athoracsur.2019.02.061

M3 - Article

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

ER -