Mitral Valve Replacement in Infants Using a 15-mm Mechanical Valve

Abstract

Background. The 15-mm mechanical valve was approved by the US Food and Drug Administration in March 2018. We review our experience in infants with this valve in the mitral position (MV), focusing on outcomes and timing to repeat MV replacement (MVR).Methods. Between 2006 and 2017 7 patients underwent eight MVRs (one repeat) with a 15-mm mechanical valve. Retrospective chart review was performed to examine short-and long-term outcomes.Results. There were no operative deaths. Mean followup was 5.8 ± 4.8 years (range, 0.72 to 11.1). Six patients underwent an MV operation 53 ± 39 days (range, 9 to 118) before MVR with the 15-mm valve. All patients were on mechanical ventilatory support at the time of operation. Mean age, body weight, and body surface area at time of 15-mm MVR were 0.5 ± 0.3 years (range, 0.2 to 0.9), 5.6 ± 0.8 kg (range, 4.8 to 6.6), and 0.29 ± 0.03 m 2 (range, 0.27 to 0.32), respectively. Two patients required pacemaker

Caution Required Contextualizing Recommendations for Infants and Neonates in a Pediatric Experience of Mitral Valve Replacement

“…[2][3][4] That was then, and things have changed. Several groups report very low mortality, [5][6][7][8][9] satisfactory functional outcomes, and reasonable freedom from reoperation in this age-group. This report 1 describes a 26-year experience of 119 mitral valve replacements in "pediatric" patients.…”

“…At the risk of purporting to be "expert," we see four important considerations in infant mitral valve replacement, some of which have been previously reported. [6][7][8][9] Firstly, avoidance of oversizing, secondly wide resection of the subvalvar apparatus that may entrap prosthetic leaflets, thirdly, placement of many fine, for example, 5/0 mattress sutures passed through a 5-mm fringe of leaflet tissue with the placement of small pledgets on the ventricular aspect, to evenly spread tension, and lastly, avoiding annular sutures and thus annular compression that may contribute to postoperative heart block and ventricular dysfunction. An inverted aortic prosthesis is sometimes the best choice for a small annulus, as the housing of the mechanism sits in the atrium, and away from the left ventricular outflow tract.…”

Commentary: In pursuit of a pediatric heart valve that can grow with the child

“…Mechanical valves remain a viable option for patients with annulus diameter of greater than 15 mm, but the promise of an expandable heart valve for growing children remains elusive. 4 When designing an expandable pediatric heart valve, several considerations arise. First and foremost is leaflet material.…”

Mechanical mitral valve replacement in children: an update

“…Recently, the first results of the smallest mechanical valve available suggest that the newly approved 15-mm valve offers a reliable strategy for palliating severe mitral disease in young children. Reasonable hope is therefore allowed to improve outcomes in the youngest children (9).…”

“…We highlight the fact that issues and outcomes concerning MVR in young children have remained unchanged for the last 20 years. In consequence, this study, besides helping medical teams in taking decisions, is pointing the fact that emerging alternatives and new armamentarium (6,9) have to be assessed in the future, in order to improve outcomes in children, especially <2 years, suffering from mitral diseases.…”