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What Factors Should Be Considered To Improve Outcome Of Mechanical Mitral Valve Replacement In Children?
Mohamed F. Elsisy, MD, Joseph A. Dearani, MD, Elena Ashikhmina, MD, Prasad Krishnan, MD, Jason H. Anderson, MD, Nathan W. Taggart, MD, Charlotte S. Van Dorn, MD, Elizabeth H. Stephens, MD.
Mayo Clinic, Rochester, MN, USA.

Objective(s):
To identify risk factors for pediatric mMVR to improve outcomes.
Methods:
1993 to 2019, 93 children underwent 119 mMVR (median age 8.8 years, 54.6% females). Twenty-six patients underwent mMVR at ≤2 years and 93 patients >2 years. 57% had a prior MVR or repair. Additional procedures included aortic valve replacement in 11% and myectomy in 6%. Median follow-up duration was 7.6 years
Results:
Operative mortality was 9.7%, but decreased with time and was 0% in the most recent era (13.9% 1993-2000, 7.3% 2001-2010, 0% 2011-2019, p=0.04). It was higher in patients ≤2 years than patients >2 years (26.9% vs. 2.2%, p<0.01). On multi-variate analysis for mitral valve reoperation, valve size <23mm was significant with a HR of 5.38 (4.87-19.47, p=0.01). Perioperative stroke occurred in 1% and permanent pacemaker was necessary in 12%. Freedom from mitral valve reoperation was higher in patients >2 years and those with ≥23 mm prosthesis. Median time to reoperation was 6.52.8 years in patients >2 years and 3.93.7 years in patients ≤2 years, p=0.04, but was similar regarding prosthesis size (p=0.6). During follow-up, there was a 11% incidence of stroke, 4% prosthetic valve thrombosis requiring reoperation, 1% significant bleeding, and 3% endocarditis.Conclusions:Early and late outcomes of mMVR in children are improved when performed at age >2 years and with prosthesis size ≥23 mm. These factors should be considered in mMVR timing.


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