Outcomes Of Mitral Valve Replacement With A Handmade Valve Using Porcine Extracellular Matrix In Neonates And Infants
Frank Scholl, MD, M Ruzmetov, Immanuel Turner, MD, Steve Bibevski, MD, PhD.
Joe DiMaggio Children's Hospital, Hollywood, FL, USA.
Objective(s): Mitral valve replacement (MVR) is the only option for infants with severe mitral valve disease that is not reparable; however outcomes are generally not favorable. This study reports our experience with MVR using a decellularized extracellular matrix (ECM) handmade valve in neonates and infants requiring mitral valve replacement.
Methods: Custom, systemic atrioventricular valves using ECM were made for neonates and infants with an annulus of <15mm. Since May 2013, six patients underwent MVR with an ECM valve. Mean patient age was 3.1+2.5 months (range, 17 days to 7 months) and a mean weight of 5.2+2.1 kg (range, 3-9.4 kg).
Results: All implants were technically successful, with no significant regurgitation and stenosis (one early patient required revision on post op day 1 for ventricular suture dehiscence). The mean diameter of implanted valve was 13.0+1.6 mm (range, 11-15). There were 2 early deaths from low cardiac output in patients with significant associated lesions. Mean follow-up period was 35.0+27.7 months (range, 9-70). During follow-up, three patients had mitral valve replacement with a larger diameter mechanical valve (n=2) or SIS-ECM valve (n=1). One patient expired 9 months after MVR due to pulmonary complications. One patient continues to do well with her second SIS-ECM valve more than 1 year after surgery.
Conclusions: A handmade mitral valve using extracellular matrix is feasible and demonstrates acceptable short-term function. It is useful as a "bailout" in challenging situations and allows for somatic growth and future implantation of a reasonably-sized mechanical prosthesis in the mitral annulus.
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