Patient–Prosthesis Mismatch Associated With Somatic Growth After Mechanical Mitral Valve Replacement in Small Children: Metrics for Reoperation and Outcomes

Nakamura, Yuji; Hoashi, Takaya; Imai, Kenta; Okuda, Naoki; Komori, Motoki; Kurosaki, Kenichi; Ichikawa, Hajime

doi:10.1053/j.semtcvs.2022.01.010

Cited by 4 publications

(7 citation statements)

References 25 publications

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“…In general, clinical outcomes of RVOT reconstruction identify a younger age at implantation as a significant risk factor in early PPVR failure and reoperation 19 . In addition to the amplified consequences of biofouling in this age group, this observation may be explained by patient outgrowth of the device 12,14,18,26,27,196 . Clinically, this is described as prosthetic‐patient mismatch (PPM), 197 which is generally indicated when the ratio of the valve's effective orifice area (EOA, a measure of the cross‐sectional area open to blood flow during systole) to the patient's body surface area decreases below 0.85 cm 2 /m 2 198,199 .…”

Section: Somatic Outgrowthmentioning

confidence: 99%

“…Clinically, this is described as prosthetic‐patient mismatch (PPM), 197 which is generally indicated when the ratio of the valve's effective orifice area (EOA, a measure of the cross‐sectional area open to blood flow during systole) to the patient's body surface area decreases below 0.85 cm 2 /m 2 198,199 . PPM has a detrimental effect on the hemodynamic profile around the valve, resulting in impaired cardiovascular function and reduced quality of life, 24 and requiring reoperation to upsize the valve 27 . The PPM may also exacerbate biological responses to the device, as a progressively non‐physiological flow profile through the HVR may promote thrombosis 200,201 .…”

Section: Somatic Outgrowthmentioning

confidence: 99%

“…Prosthetic failure is generally exacerbated in the pediatric population due to their active lifestyle and robust immune responses accelerating adverse biological responses and structural degradation 24,25 . Furthermore, the somatic growth of pediatric patients is not accommodated by current PV prosthetics, which all operate at a fixed diameter 12,14,26,27 . A growing mismatch between patient and prosthetic sizes gradually impairs hemodynamic performance and cardiovascular health 24 .…”

Section: Introductionmentioning

confidence: 99%

“… 24 , 25 Furthermore, the somatic growth of pediatric patients is not accommodated by current PV prosthetics, which all operate at a fixed diameter. 12 , 14 , 26 , 27 A growing mismatch between patient and prosthetic sizes gradually impairs hemodynamic performance and cardiovascular health. 24 Taken together, these failure modes result in an unacceptably high requirement for reoperation in the pediatric population, leaving the patient and family under sustained physical, emotional, and financial hardships.…”

Section: Introductionmentioning

confidence: 99%

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Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies

Crago

Winlaw

Farajikhah

et al. 2023

Bioengineering & Transla Med

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Congenital heart diseases (CHDs) frequently impact the right ventricular outflow tract, resulting in a significant incidence of pulmonary valve replacement in the pediatric population. While contemporary pediatric pulmonary valve replacements (PPVRs) allow satisfactory patient survival, their biocompatibility and durability remain suboptimal and repeat operations are commonplace, especially for very young patients. This places enormous physical, financial, and psychological burdens on patients and their parents, highlighting an urgent clinical need for better PPVRs. An important reason for the clinical failure of PPVRs is biofouling, which instigates various adverse biological responses such as thrombosis and infection, promoting research into various antifouling chemistries that may find utility in PPVR materials. Another significant contributor is the inevitability of somatic growth in pediatric patients, causing structural discrepancies between the patient and PPVR, stimulating the development of various growthaccommodating heart valve prototypes. This review offers an interdisciplinary perspective on these challenges by exploring clinical experiences, physiological understandings, and bioengineering technologies that may contribute to device development. It thus aims to provide an insight into the design requirements of next-generation PPVRs to advance clinical outcomes and promote patient quality of life.

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Section: Somatic Outgrowthmentioning

confidence: 99%

Section: Somatic Outgrowthmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies

Crago

Winlaw

Farajikhah

et al. 2023

Bioengineering & Transla Med

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show abstract

“…However, for complex aortic valve disease which routine aortic valve repair usually fails to deal with ( 2 ), aortic valve replacement (AVR) is supposed to be unavoidable. AVR still has many limitations in children such as rapid deterioration ( 3 , 4 ) in bioprosthetic valves, high risk of anticoagulation-related complications ( 5 , 6 ) in mechanical valves as well as size mismatch in young patients with small annuluses ( 7 ). The Ross procedure is a good option for young children but it is not widely applied in developing countries due to relatively high mortality, lack of valved conduit, and risk of impacting both semilunar valves ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

A midterm follow-up study of the application of a confluent aortic valve neocuspidization technique with pericardium in children

Huang,

Zhang,

Jia

et al. 2023

Transl Pediatr

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Background The treatment of aortic valve diseases in children remains a great challenge. We aim to report outcomes and midterm follow-up data of our confluent neocuspidization technique with pericardium for aortic valve replacement (AVR) in children. Methods A retrospective analysis was performed on all 20 children who underwent the confluent neocuspidization technique with pericardium at Children’s Hospital of Fudan University from March 2017 to May 2022. Outcome measures included echocardiographic measurements, surgical intervention, and mortality. Results A total of 20 patients (17 males vs. 3 females), with a median age of 7.5 years [min–max, 0.3–12 years; interquartile range (IQR), 4.4–9.7 years], a median body weight of 24.0 kg (min–max, 6.0–52.3 kg; IQR, 15.6–31.0 kg), and median aortic valve annulus size before surgery of 19.0 mm (min–max, 11.0–25.0 mm; IQR, 17.1–21.5 mm), underwent the neocuspidization technique with pericardium (17 autologous pericardia and 3 bovine patch). With 50% of bicuspid aortic valve and 50% of tricuspid, they were respectively diagnosed as aortic stenosis (AS) (7/20, 35%), aortic regurgitation (AR) (8/20, 40%) and mixed AS and AR (AS & AR) (5/20, 25%). The median postoperative follow-up time was 19 months (min–max, 5–61 months; IQR, 16.3–35 months). The peak pressure gradient across the aortic valve decreased from 81.0±37.0 mmHg in AS group and AS & AR group before surgery to 25.9±15.8 mmHg within 24 hours after surgery (P<0.001) and was mostly around 25 mmHg during follow-up. All patients presented mild or less than mild regurgitation within 24 hours after surgery. There were no hospital mortalities. Three patients needed reintervention during follow-up. There was one late death related to mitral valve stenosis. Conclusions Though the confluent neocuspidization technique with pericardium provided immediate relief of significant AS or regurgitation, the midterm outcome was suboptimal. More research is needed to find the optimal material for AVR.

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Commentary: Evaluating Pediatric Mitral Valve Patient-Prosthetic Mismatch—When Is Too Small, Too Small?

Chai

2023

Seminars in Thoracic and Cardiovascular Surgery

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Patient–Prosthesis Mismatch Associated With Somatic Growth After Mechanical Mitral Valve Replacement in Small Children: Metrics for Reoperation and Outcomes

Cited by 4 publications

References 25 publications

Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies

Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies

A midterm follow-up study of the application of a confluent aortic valve neocuspidization technique with pericardium in children

Commentary: Evaluating Pediatric Mitral Valve Patient-Prosthetic Mismatch—When Is Too Small, Too Small?

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