Mitral Valve Replacement in Infants using a 15-mm Mechanical Valve
Osama M. Eltayeb, MD, William J. Readdy, Michael C. Monge, MD, Joseph M. Forbess, MD, Anne E. Sarwark, MSc, Carl L. Backer, MD.
Ann & Robert H Lurie Childrens Hospital of Chicago, Chicago, IL, USA.
Objective(s): 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) because of somatic growth.
Methods: Between 2006-2017, 7 patients underwent 8 MVRs (1 repeat) with 15-mm mechanical valve. We performed a retrospective chart review 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). Six patients underwent MV operation prior to 15-mm MVR. Mean time from valvuloplasty to MVR was 53±39 (9-118) days. All patients were on mechanical ventilatory support at 15-mm MVR. Mean age, body weight, and BSA at time of 15-mm MVR were 0.5±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. One patient required pacemaker implantation for 3° AV block. Two patients are doing well at 10 and 18 months. Four patients underwent re-MVR due to patient-prosthesis mismatch due to somatic growth. Mean time to repeat MVR was 23 months. There were 2 late deaths, 1 at 10 months unrelated to the valve. The other patient, who also had congenital diaphragmatic hernia, had early re-MVR due to prosthetic thrombosis. The child died of multiple complications after 4th MVR, 2 years after 15-mm MVR.
Conclusions: 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.
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