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Overman DM, Moga FX, Stephens EH, Dearani JA, MacIver RH. Infant Mitral Valve Replacement: Current State of the Art. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 26:75-80. [PMID: 36842801 DOI: 10.1053/j.pcsu.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Abstract
Mitral valve replacement (MVR) in the very young is an imposing clinical challenge. Early and late mortality risk is substantial, severe adverse events are common, and redo mitral valve replacement is inevitable. Therapeutic options are limited. In the older infant with an annulus of 17mm or larger, mechanical MVR is associated with low risk of mortality and predictable durability. For the very young with annular hypoplasia, bovine jugular vein conduit MVR appears to offer equivalent or better early outcomes with the possibility of subsequent valve expansion, potentially prolonging the interval to redo MVR. Experience with cylinder MVR and other forms of surgeon-manufactured MVR is quite limited, and there is currently no information on late outcomes or durability.
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Affiliation(s)
- David M Overman
- Division of Cardiac Surgery, The Children's Heart Clinic and Children's Minnesota, Minneapolis, MN, USA; Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, MN, USA; Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA.
| | - Francis X Moga
- Division of Cardiac Surgery, The Children's Heart Clinic and Children's Minnesota, Minneapolis, MN, USA; Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, MN, USA; Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA
| | - Elizabeth H Stephens
- Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA; Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph A Dearani
- Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA; Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robroy H MacIver
- Division of Cardiac Surgery, The Children's Heart Clinic and Children's Minnesota, Minneapolis, MN, USA; Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, MN, USA; Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA
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Sampathkumar A. Mitral valve replacement in infants. Ann Pediatr Cardiol 2021; 14:249. [PMID: 34103874 PMCID: PMC8174630 DOI: 10.4103/apc.apc_29_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Arkalgud Sampathkumar
- Department of Cardiothoracic Surgery, AIIMS, New Delhi, India.,Senior Consultant, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India. E-mail:
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Blitzer D, Herrmann JL, Brown JW. Pulmonary Autograft Mitral Valve Replacement (Ross II): Long-Term Follow-Up of a US Center. World J Pediatr Congenit Heart Surg 2018; 9:645-650. [PMID: 30322368 DOI: 10.1177/2150135118792196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mitral valve replacement (MVR) with a pulmonary autograft (Ross II) may be a useful technique for pediatric and young adult patients who wish to avoid anticoagulation. Our aim was to evaluate the long-term outcomes of the Ross II procedure at our institution. METHODS Patients undergoing the Ross II procedure between June 2002 and April 2008 were included. Preoperative diagnoses included rheumatic disease (n = 5), congenital mitral valve (MV) pathology (partial atrioventricular canal defect [n = 2], complete atrioventricular canal defect [n = 1], Shone's complex [n = 1]), and myocarditis (n = 1). RESULTS Ten patients (eight females and two males) between 7 months and 46 years were included. Mean age at surgery was 25.2 ± 15.7 years. There were no in-hospital deaths. Mean follow-up was 11.7 ± 5.2 years. There were three late deaths at 11 months, 5 years, and 11 years, respectively. Causes of death included right heart failure, sepsis, and sudden cardiac arrest. Three patients required subsequent mechanical MVR a median of two years after the Ross II procedure (range: 1-4 years). There was no mortality with reoperation. Echocardiographic follow-up demonstrated mean MV gradients ranging from 2.2 to 9.6 mm Hg. Two patients had greater than mild MV regurgitation postoperatively, and all others had minimal mitral regurgitation or less. Two patients developed moderate MV stenosis. CONCLUSIONS The Ross II procedure is an option for select older children and young adults desiring a durable tissue MVR to avoid long-term anticoagulation.
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Affiliation(s)
- David Blitzer
- 1 Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeremy L Herrmann
- 1 Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.,2 Department of Cardiothoracic Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - John W Brown
- 1 Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.,2 Department of Cardiothoracic Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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Sughimoto K, Konstantinov IE, d'Udekem Y, Brink J, Zannino D, Brizard CP. Mid-term outcomes of congenital mitral valve surgery: Shone's syndrome is a risk factor for death and reintervention. Interact Cardiovasc Thorac Surg 2018; 25:734-739. [PMID: 29049550 DOI: 10.1093/icvts/ivx211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 05/29/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To study the recent trends and outcomes of congenital mitral valve surgery in children. METHODS From 2008 to 2014, 84 procedures in 66 consecutive patients (41 procedures in 31 patients with mitral stenosis and 43 procedures in 35 patients with mitral regurgitation) were retrospectively evaluated. The mean age at surgery was 4.3 ± 5.4 years, and 27 patients (41%) were neonates or infants. RESULTS Seven (11%) patients died during the follow-up period of 3.2 ± 2.3 years and 5 (71%) were <1 year. Ten mitral valve replacements were performed in 8 patients, including 1 pulmonary valve homograft, 3 Contegra conduits of 12 mm thickness in the intra-annular position and 6 mechanical valves. Shone's syndrome, dysplastic valve, a need for valve replacement and age <1 year were the risk factors for death or reoperation in a univariable analysis, while in a multivariable analysis of all patients, valve replacement and age <1 year remained as risk factors. In a multivariable analysis of 27 patients aged <1 year, mitral valve dysplasia was a significant risk factor for reoperation or death. The 5-year rate of freedom from death or reoperation in neonates or infants was 55% and that in patients aged >1 year was 88% (P = 0.003). CONCLUSIONS An age of <1 year, mitral valve dysplasia and a need for mitral valve replacement were associated with a higher incidence of death or reoperation. Primary mitral valve replacement or univentricular strategy may have to be considered for symptomatic neonates with Shone's syndrome.
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Affiliation(s)
- Koichi Sughimoto
- Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Johann Brink
- Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Diana Zannino
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Phuong N, Chang P, Starnes V, Shinbane JS. Cardiovascular Magnetic Resonance of the Ross II Procedure: Long-Term Postoperative Imaging. World J Pediatr Congenit Heart Surg 2017; 8:398-399. [DOI: 10.1177/2150135117701129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Newton Phuong
- Division of Cardiovascular Medicine/Cardiovascular and Thoracic Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Philip Chang
- Division of Cardiovascular Medicine/Cardiovascular and Thoracic Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Vaughn Starnes
- Division of Cardiovascular Medicine/Cardiovascular and Thoracic Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jerold S. Shinbane
- Division of Cardiovascular Medicine/Cardiovascular and Thoracic Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Feasibility and early effectiveness of a custom, hand-made systemic atrioventricular valve using porcine extracellular matrix (CorMatrix) in a 4-month-old infant. Ann Thorac Surg 2015; 99:710-2. [PMID: 25639419 DOI: 10.1016/j.athoracsur.2014.04.140] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/28/2014] [Accepted: 04/29/2014] [Indexed: 11/21/2022]
Abstract
A need persists for a prosthetic, systemic atrioventricular valve replacement in the pediatric population that can be customized to a wide range of annular sizes, has a low risk of thrombosis, possesses optimal hemodynamic performance, and has the potential to remodel and grow with the patient. We describe a technique for successful systemic atrioventricular valve replacement in a 4-month-old infant by use of a handmade, bileaflet systemic atrioventricular prosthesis constructed from porcine extracellular matrix.
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Evolution of Mitral Valve Replacement in Children: A 40-Year Experience. Ann Thorac Surg 2012; 93:626-33; discussion 633. [DOI: 10.1016/j.athoracsur.2011.08.085] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 08/27/2011] [Accepted: 08/30/2011] [Indexed: 11/18/2022]
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Henaine R, Nloga J, Wautot F, Yoshimura N, Rabilloud M, Obadia JF, Di-Filippo S, Ninet J. Long-Term Outcome After Annular Mechanical Mitral Valve Replacement in Children Aged Less Than Five Years. Ann Thorac Surg 2010; 90:1570-6. [DOI: 10.1016/j.athoracsur.2010.06.121] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 06/24/2010] [Accepted: 06/29/2010] [Indexed: 11/16/2022]
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Pace Napoleone C, Oppido G, Angeli E, Giardini A, Gargiulo G. Ross-kabbani operation in an infant with mitral valve dysplasia. Cardiol Res Pract 2010; 2009:593659. [PMID: 20049318 PMCID: PMC2796443 DOI: 10.4061/2009/593659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 09/15/2009] [Indexed: 11/20/2022] Open
Abstract
Background. Mitral valve replacement can be very difficult to obtain in infants because the valve annulus diameter can be smaller than the available prosthesis. Case Report. We describe the case of a 2-month-old female weighing 3.5 kg affected by mitral valve dysplasia leading to severe valve stenosis. Despite full medication, the clinical conditions were critical and surgery was undertaken. The mitral valve was unsuitable for repair and the orifice of mitral anulus was 12 mm, too small for a mechanical prosthesis. Therefore, a Ross-Kabbani operation was undertaken, replacing the mitral valve with the pulmonary autograft and reconstructing the right ventricular outflow tract with an etherograft. Results. The postoperative course was uneventful and the clinical conditions are good at 4-month follow-up.
Conclusion. The Ross-Kabbani operation can be an interesting alternative to mitral valve replacement in infants when valve repair is not achievable and there is little space for an intra-annular mechanical prosthesis implant.
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Affiliation(s)
- Carlo Pace Napoleone
- Department of Pediatric Cardiac Surgery, University of Bologna Medical School, 40138 Bologna, Italy
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Kumar AS, Talwar S, Gupta A. Mitral valve replacement with the pulmonary autograft: Midterm results. J Thorac Cardiovasc Surg 2009; 138:359-64. [DOI: 10.1016/j.jtcvs.2008.11.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Revised: 09/21/2008] [Accepted: 11/25/2008] [Indexed: 10/21/2022]
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Mitral valve replacement with the pulmonary autograft in children: a word of caution. Pediatr Cardiol 2009; 30:831-3. [PMID: 19357909 DOI: 10.1007/s00246-009-9431-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 01/14/2009] [Accepted: 03/11/2009] [Indexed: 10/20/2022]
Abstract
A 4(1/2)-month-old patient who underwent mitral valve replacement for congenital mitral stenosis using a pulmonary autograft is reported. Failure of the autograft resulted in pulmonary hypertension, leading to pulmonary regurgitation in the reconstructed right ventricular outflow tract, then tricuspid regurgitation, refractory right heart failure, and death. Caution should be exercised in applying this procedure with children, particularly those at risk for pulmonary hypertension.
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Lamberti JJ, Kriett JM. Mitral/systemic atrioventricular valve repair in congenital heart disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007:94-100. [PMID: 17433999 DOI: 10.1053/j.pcsu.2007.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Because there is no ideal substitute for the mitral or the systemic atrioventricular valve (SAVV) in a patient of any age, repair is the optimal treatment for important congenital or acquired mitral/SAVV disease. Valve repair techniques have evolved to the point where early repair may be offered to asymptomatic patients with favorable anatomy. The indications for operation depend on the presence or absence of symptoms and the physiologic consequences of mitral/SAVV pathology. Concomitant arrhythmia surgery may be appropriate in selected cases. Surgical outcomes are good to excellent when appropriate techniques are used. Repair of congenital SAVV abnormalities is safe and durable in many patients.
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Affiliation(s)
- John J Lamberti
- Children's Heart Institute, Rady Children's Hospital-San Diego, University of California, San Diego, CA, USA.
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Husain SA, Brown JW. When reconstruction fails or is not feasible: valve replacement options in the pediatric population. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007:117-24. [PMID: 17434003 DOI: 10.1053/j.pcsu.2007.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Valvular pathology in infants and children poses numerous challenges to the pediatric cardiac surgeon. Without question, valvular repair is the goal of intervention because restoration of valvular anatomy and physiology using native tissue allows for growth and a potentially better long-term outcome. When reconstruction fails or is not feasible, valve replacement becomes inevitable. Which valve for which position is controversial. The goal of this article is to address valve replacement options for all four valve positions within the pediatric population. We will draw from our institutional experience and review current literature to support our preferences.
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Affiliation(s)
- S Adil Husain
- Congenital Heart Center, Department of Pediatrics, University of Florida School of Medicine, Gainesville, FL 32610, USA.
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14
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Graham TP. The year in congenital heart disease. J Am Coll Cardiol 2006; 47:2545-53. [PMID: 16781386 DOI: 10.1016/j.jacc.2006.04.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 04/06/2006] [Accepted: 04/11/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Thomas P Graham
- Vanderbilt Children's Hospital, Nashville, Tennessee 37232-9119., USA.
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