Skip to main content

Advertisement

SpringerLink
Log in

Mitral Valve Surgery in the First Year of Life

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Data are limited on outcomes associated with mitral valve surgery in infants. Prior studies report high mortality and increased risk for late cardiac failure particularly for those with mitral stenosis. We sought to evaluate outcomes in patients with mitral stenosis (MS) or regurgitation (MR) who had mitral valvuloplasty or replacement in the first year of life. A retrospective analysis of all patients in a single institution who underwent mitral valvuloplasty or replacement in their first year of life from 2004 to 2016 (n = 25), excluding patients with single ventricle pathology or those undergoing surgery for atrioventricular canal defect, was carried out. Median age and weight at surgery were 76.5 days (range 2–329) and 4.5 kg (range 3.0–10.1), respectively. The primary mitral pathology was MR in 16 and MS in 9 patients. Median follow-up among living patients was 4 years (range 106 days–12.3 years). Overall survival was 96% at 30 days and 87.8% at 1, 5, and 10 years. There were three early deaths (12%), all within 6 weeks of surgery. There were no late deaths. Three patients required valve replacement, 1 of which had a primary mitral valve replacement and died within 30 days of surgery. Re-intervention-free survival (surgical and catheter based) was 83.8%, 73.3%, and 48.9% at 1, 5, and 10 years per Kaplan–Meier estimates. There was no difference in re-intervention-free survival between patients with MR versus MS. No risk factors for death or re-intervention were identified. Mitral valvuloplasty and replacement can be performed in infants under 1 year of age with acceptable survival and need for re-intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

ALCAPA:

Anomalous left coronary artery from the pulmonary artery

ASD:

Atrial septal defect

ASO:

Arterial switch operation

Coarct:

Coarctation of the aorta

DILV:

Double inlet left ventricle

DORV:

Double outlet right ventricle

ECMO:

Extracorporeal membrane oxygenation

LVOTO:

Left ventricular outflow tract obstruction

LVEDd:

Left ventricular end systolic dimension

MR:

Mitral regurgitation

MS:

Mitral stenosis

PDA:

Patent ductus arteriosus

PFO:

Patent foramen ovale

PS:

Pulmonary stenosis

SF:

Shortening fraction

TGA:

Transposition of the great arteries

TEE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

VSD:

Ventricular septal defect

References

  1. Günther T, Mazzitelli D, Schreiber C et al (2000) Mitral-valve replacement in children under 6 years of age. Eur J Cardiothorac Surg 17(4):426–430

    Article  Google Scholar 

  2. Caldarone CA, Raghuveer G, Hills CB et al (2001) Long-term survival after mitral valve replacement in children aged %3c 5 years: a multi-institutional study. Circulation 10:1–143

    Google Scholar 

  3. Brown JW, Fiore AC, Ruzmetov M et al (2012) Evolution of mitral valve replacement in children: a 40-year experience. Ann Thorac Surg 93:626–633

    Article  Google Scholar 

  4. Erez E, Kanter KR, Isom E, Williams WH, Tam VK (2003) Mitral valve replacement in children. J Heart Valve Dis 12:25–29

    PubMed  Google Scholar 

  5. Beierlein W, Becker V, Yates R et al (2007) Long-term follow-up after mitral valve replacement in childhood: poor event-free survival in the young child. Eur J Cardiothorac Surg 31:860–865

    Article  Google Scholar 

  6. Rafii DY, Davies RR, Carroll SJ et al (2011) Age less than two years is not a risk factor for mortality after mitral valve replacement in children. Ann Thorac Surg 91:1228–1234

    Article  Google Scholar 

  7. Aharon AS, Laks H, Drinkwater DC et al (1994) Early and late results of mitral valve repair in children. J Thorac Cardiovasc Surg 107:1262–1271

    Article  CAS  Google Scholar 

  8. Chauvaud S, Fuzellier JF, Houel R et al (1998) Reconstructive surgery in congenital mitral valve insufficiency (Carpentier's techniques): long-term results. J Thorac Cardiovasc Surg 115:84–93

    Article  CAS  Google Scholar 

  9. Ohno H, Imai Y, Terada M, Hiramatsu T (1999) The long-term results of commissure plication annuloplasty for congenital mitral insufficiency. Ann Thorac Surg 68:537–541

    Article  CAS  Google Scholar 

  10. Shi Y, Xu H, Yan J et al (2017) The mid-term results of mitral valve repair for isolated mitral regurgitation in infancy and childhood. Pediatr Cardiol 38:1592–1597

    Article  Google Scholar 

  11. Curi-Curi P, Ramírez-Marroquín S, Cervantes-Salazar J, Soulé M, Erdmenger J, Calderón-Colmenero J (2010) Surgical repair of congenital mitral valve malformations. Arch Cardiol Mex 80:87–94

    PubMed  Google Scholar 

  12. Stellin G, Padalino MA, Vida VL et al (2010) Surgical repair of congenital mitral valve malformations in infancy and childhood: a single-center 36-year experience. J Thorac Cardiovasc Surg 140:1238–1244

    Article  Google Scholar 

  13. Jiang Z, Mei J, Ding F et al (2014) The early and mid-term results of mitral valve repair for mitral regurgitation in children. Surg Today 44:2086–2091

    Article  Google Scholar 

  14. Lopez L, Colan S, Stylianou M et al (2017) Relationship of echocardiographic: the pediatric heart network normal echocardiogram databases: the pediatric heart network normal echocardiogram database scores adjusted for body surface area to age, sex, race, and ethnicity: the pediatric heart network normal echocardiogram database. Circ Cardiovasc Imaging 10:e006979

    Article  Google Scholar 

  15. Sughimoto K, Konstantinov IE, d’Udekem Y et al (2017) Mid-term outcomes of congenital mitral valve surgery: Shone’s syndrome is a risk factor for death and reintervention. Interact Cardiovasc Thorac Surg 25:734–739

    Article  Google Scholar 

  16. Hetzer R, Delmo Walter EB, Hübler M et al (2008) Modified surgical techniques and long-term outcome of mitral valve reconstruction in 111 children. Ann Thorac Surg 86:604–613

    Article  Google Scholar 

  17. Frigiola A, Pluchinotta FR, Saracino A, Giamberti A, Arcidiacono C, Piazza L, Reali M, Butera G, Varrica A, Carminati M (2017) Surgical mitral valve replacement with the Melody valve in infants and children: the Italian experience. EuroIntervention 12:2104–2109

    Article  Google Scholar 

  18. Quiñonez LG, Breitbart R, Tworetsky W, Lock JE, Marshall AC, Emani SM (2014) Stented bovine jugular vein graft (Melody valve) for surgical mitral valve replacement in infants and children. J Thorac Cardiovasc Surg 148:1443–1449

    Article  Google Scholar 

  19. Murala JS, Sassalos P, Owens ST, Ohye RG (2017) Porcine small intestine submucosa cylinder valve for mitral and tricuspid valve replacement. J Thorac Cardiovasc Surg 154:57–59

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Dr. Robert Jaquiss for his guidance and mentorship in the presentation of this project.

Funding

No funding source was obtained for preparation of this study.

Author information

Authors and Affiliations

  1. The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Tracy R. Geoffrion

  2. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Timothy J. Pirolli, Jessica Pruszynski & Ryan R. Davies

  3. Children’s Medical Center, Dallas, TX, USA

    Timothy J. Pirolli & Ryan R. Davies

  4. Cook Children’s Hospital, Fort Worth, TX, USA

    Adrian K. Dyer

  5. Ann and Robert H. Lurie Children’s Hospital, Chicago, IL, USA

    Joseph M. Forbess

  6. Medical City Hospital, Dallas, TX, USA

    Kristine J. Guleserian

Authors
  1. Tracy R. Geoffrion
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timothy J. Pirolli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jessica Pruszynski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adrian K. Dyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryan R. Davies
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joseph M. Forbess
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kristine J. Guleserian
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Conceptualization: KG and JF methodology; KG, TP, and RD material preparation, data collection and analysis; TG, TP, JP, and AD the first draft of the manuscript was written by TG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tracy R. Geoffrion.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest or disclosures.

Ethical Approval

This retrospective study is in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research Involving with Humans and Animals Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

The need for informed consent was waived by the IRB.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 17 kb)

Supplementary material 2 (DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Geoffrion, T.R., Pirolli, T.J., Pruszynski, J. et al. Mitral Valve Surgery in the First Year of Life. Pediatr Cardiol 41, 334–340 (2020). https://doi.org/10.1007/s00246-019-02262-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-019-02262-5

Keywords

Search

Navigation