Mitral valve replacement in children

Predictors of long-term outcome

Brian K. Eble, William P. Fiser, Pippa Simpson, Judith Dugan, Jonathan J. Drummond-Webb, Angela T Yetman

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background. Mitral valve replacement (MVR) in children has been associated with a high complication rate. We sought to assess predictors of outcomes in children undergoing MVR. Methods. A retrospective review of clinical, surgical, and echocardiographic records of patients undergoing MVR was performed. Between 1982 and 2000, 53 children underwent 76 MVR procedures at a median age of 5 years (range, 1 day to 18 years) and weight of 17 kg (range, 3 to 121 kg). Eighteen patients (34%) had more than one MVR. Previous cardiac surgery had been performed in 39 (74%), with 27 (51%) undergoing previous mitral repair. Patients were followed for 9.2 ± 4.8 (range, 2 to 20) years. Results. There were 14 patient deaths, with 6 patients dying within 30 days, and five transplants (36%). Ten-year freedom from reoperation was 66%. Long-term survivors were older at initial repair (7.0 vs 2.5 years, p = 0.02), with a lower incidence of residual cardiac lesions (3% vs 37%, p < 0.001) and a lower incidence of surgical procedures at the time of MVR (31% vs 63%, p = 0.04). Survivors had better left ventricular function preoperatively (ejection fraction, 68% vs 54%; p = 0.001) and placement of a prosthetic valve within 1 z-score of the echocardiographically measured mitral valve annulus (p = 0.02). Conclusions. Adverse outcome after MVR is common, particularly in the young child undergoing palliative surgery or requiring additional surgical procedures. Preoperative assessment of mitral valve size and ventricular function is essential for risk stratification of these patients.

Original languageEnglish (US)
Pages (from-to)853-859
Number of pages7
JournalAnnals of Thoracic Surgery
Volume76
Issue number3
DOIs
StatePublished - Sep 1 2003

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Mitral Valve
Survivors
Ventricular Function
Incidence
Palliative Care
Reoperation
Left Ventricular Function
Thoracic Surgery
Transplants
Weights and Measures

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Mitral valve replacement in children : Predictors of long-term outcome. / Eble, Brian K.; Fiser, William P.; Simpson, Pippa; Dugan, Judith; Drummond-Webb, Jonathan J.; Yetman, Angela T.

In: Annals of Thoracic Surgery, Vol. 76, No. 3, 01.09.2003, p. 853-859.

Research output: Contribution to journalArticle

Eble, BK, Fiser, WP, Simpson, P, Dugan, J, Drummond-Webb, JJ & Yetman, AT 2003, 'Mitral valve replacement in children: Predictors of long-term outcome', Annals of Thoracic Surgery, vol. 76, no. 3, pp. 853-859. https://doi.org/10.1016/S0003-4975(03)00661-1
Eble, Brian K. ; Fiser, William P. ; Simpson, Pippa ; Dugan, Judith ; Drummond-Webb, Jonathan J. ; Yetman, Angela T. / Mitral valve replacement in children : Predictors of long-term outcome. In: Annals of Thoracic Surgery. 2003 ; Vol. 76, No. 3. pp. 853-859.
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abstract = "Background. Mitral valve replacement (MVR) in children has been associated with a high complication rate. We sought to assess predictors of outcomes in children undergoing MVR. Methods. A retrospective review of clinical, surgical, and echocardiographic records of patients undergoing MVR was performed. Between 1982 and 2000, 53 children underwent 76 MVR procedures at a median age of 5 years (range, 1 day to 18 years) and weight of 17 kg (range, 3 to 121 kg). Eighteen patients (34{\%}) had more than one MVR. Previous cardiac surgery had been performed in 39 (74{\%}), with 27 (51{\%}) undergoing previous mitral repair. Patients were followed for 9.2 ± 4.8 (range, 2 to 20) years. Results. There were 14 patient deaths, with 6 patients dying within 30 days, and five transplants (36{\%}). Ten-year freedom from reoperation was 66{\%}. Long-term survivors were older at initial repair (7.0 vs 2.5 years, p = 0.02), with a lower incidence of residual cardiac lesions (3{\%} vs 37{\%}, p < 0.001) and a lower incidence of surgical procedures at the time of MVR (31{\%} vs 63{\%}, p = 0.04). Survivors had better left ventricular function preoperatively (ejection fraction, 68{\%} vs 54{\%}; p = 0.001) and placement of a prosthetic valve within 1 z-score of the echocardiographically measured mitral valve annulus (p = 0.02). Conclusions. Adverse outcome after MVR is common, particularly in the young child undergoing palliative surgery or requiring additional surgical procedures. Preoperative assessment of mitral valve size and ventricular function is essential for risk stratification of these patients.",
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N2 - Background. Mitral valve replacement (MVR) in children has been associated with a high complication rate. We sought to assess predictors of outcomes in children undergoing MVR. Methods. A retrospective review of clinical, surgical, and echocardiographic records of patients undergoing MVR was performed. Between 1982 and 2000, 53 children underwent 76 MVR procedures at a median age of 5 years (range, 1 day to 18 years) and weight of 17 kg (range, 3 to 121 kg). Eighteen patients (34%) had more than one MVR. Previous cardiac surgery had been performed in 39 (74%), with 27 (51%) undergoing previous mitral repair. Patients were followed for 9.2 ± 4.8 (range, 2 to 20) years. Results. There were 14 patient deaths, with 6 patients dying within 30 days, and five transplants (36%). Ten-year freedom from reoperation was 66%. Long-term survivors were older at initial repair (7.0 vs 2.5 years, p = 0.02), with a lower incidence of residual cardiac lesions (3% vs 37%, p < 0.001) and a lower incidence of surgical procedures at the time of MVR (31% vs 63%, p = 0.04). Survivors had better left ventricular function preoperatively (ejection fraction, 68% vs 54%; p = 0.001) and placement of a prosthetic valve within 1 z-score of the echocardiographically measured mitral valve annulus (p = 0.02). Conclusions. Adverse outcome after MVR is common, particularly in the young child undergoing palliative surgery or requiring additional surgical procedures. Preoperative assessment of mitral valve size and ventricular function is essential for risk stratification of these patients.

AB - Background. Mitral valve replacement (MVR) in children has been associated with a high complication rate. We sought to assess predictors of outcomes in children undergoing MVR. Methods. A retrospective review of clinical, surgical, and echocardiographic records of patients undergoing MVR was performed. Between 1982 and 2000, 53 children underwent 76 MVR procedures at a median age of 5 years (range, 1 day to 18 years) and weight of 17 kg (range, 3 to 121 kg). Eighteen patients (34%) had more than one MVR. Previous cardiac surgery had been performed in 39 (74%), with 27 (51%) undergoing previous mitral repair. Patients were followed for 9.2 ± 4.8 (range, 2 to 20) years. Results. There were 14 patient deaths, with 6 patients dying within 30 days, and five transplants (36%). Ten-year freedom from reoperation was 66%. Long-term survivors were older at initial repair (7.0 vs 2.5 years, p = 0.02), with a lower incidence of residual cardiac lesions (3% vs 37%, p < 0.001) and a lower incidence of surgical procedures at the time of MVR (31% vs 63%, p = 0.04). Survivors had better left ventricular function preoperatively (ejection fraction, 68% vs 54%; p = 0.001) and placement of a prosthetic valve within 1 z-score of the echocardiographically measured mitral valve annulus (p = 0.02). Conclusions. Adverse outcome after MVR is common, particularly in the young child undergoing palliative surgery or requiring additional surgical procedures. Preoperative assessment of mitral valve size and ventricular function is essential for risk stratification of these patients.

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