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Extracellular Matrix Atrioventricular Valve Replacement In Pediatric Patients: A Multi-center Case Series
Muhammad Abdullah Shaikh, MD1, Darren Turner, MD1, Mark Ruzmetov, MD, PhD2, Peter Gruber, MD, PhD3, David Morales, MD1, Frank Scholl, MD2.
1Cincinnati Children's Hospital, Cincinnati, OH, USA, 2Joe DiMaggio Children's Hospital, Hollywood, FL, USA, 3Yale University School of Medicine, New Haven, CT, USA.
Objective(s): We report the successful use of extracellular matrix bioprosthetic in a diverse pediatric cohort starting with off-label surgeon-constructed ECM valves moving to 3rd generation manufactured ECM valves
Methods: We conducted a retrospective review of mitral valve(MVR) and tricuspid valve(TVR) replacement at two US institutions using two types of AVVR from 2013-2025.
Results: In 25 patients, 18(69%) used surgeon-constructed valves, and 7(27%) used manufactured valves. 14 underwent TVR(54%), and 11 underwent MVR(42%). Of the 14 TVR, 8 were performed using surgeon-constructed and 6 using manufactured valves; of the 11 MVR, 10 used surgeon-constructed and 1 used a manufactured valve. Overall survival was 60%(15/25), with surgeon-constructed valves achieving 44%(8/18) and manufactured valves 100%(7/7). TVR survival was 71%(10/14): 50%(4/8) for surgically-constructed and 100%(6/6) for manufactured valves. MVR survival to discharge was 45%(5/11): 40%(4/10) for surgeon-constructed and 100%(1/1) for the manufactured valve. In-hospital MVR valve reoperation occurred in 60%(3/5) at a median of 5 days; post-discharge reintervention occurred in 80%(4/5) at a median of 5 months(range 1.9-13). In-hospital TVR valve reoperation occurred in one surgically-constructed case at POD23. Surgeon-constructed TVR valves continue to function at 7 and 11 years post-implantation. At median follow-up of 24-months, TVR survivors demonstrated median EF of 62%, low transvalvular gradients(range:1.9-6.1 mmHg), and 11% with severe regurgitation.
Conclusions: ECM AVVR represents a viable and durable valve replacement option. Manufactured valves demonstrated excellent durability, functionality, and 100% survival. Surgically-constructed valves showed higher reintervention rates, but provided a viable therapy for critically ill patients.
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