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Sung-Un Paek
Hans Meisner
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Eur J Cardiothorac Surg 2000;17:426-430
© 2000 Elsevier Science NL

Mitral-valve replacement in children under 6 years of age

Thomas Günther, Domenico Mazzitelli, Christian Schreiber, Michael Wottke, Sung-Un Paek, Hans Meisner, Rüdiger Lange

Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum, Klinik an der Technischen, Universität München, Lazarettstraße 36, 80636 Munich, Germany

Corresponding author. Tel.: +49-89-1218-4111; fax: +49-89-1218-4113
e-mail: chinfo{at}dhm.mhn.de

Objective: In patients with congenital mitral-valve disease, reconstructive surgery is the primary goal. However, in cases with severely dysplastic valves or failed repair, mitral-valve replacement (MVR) is the only option. We analyzed, retrospectively, data of 35 patients younger than 6 years of age, who underwent MVR at our institution.Methods: Between 1974 and 1997, 35 children underwent MVR. The ages ranged from 2.7 months to 5.5 years (mean=1.9±1.7 years) and body weight varied between 3.2 and 16.7 kg (mean=8.2±4 kg). The main indication (57%) for valve replacement was severe mitral-valve insufficiency. Eighteen patients (51%) had undergone at least one previous reconstructive operation (mean=1.46±1.86 years) before the MVR. In 29 cases (83%), mechanical prostheses were implanted. Six patients received a bioprosthesis. The size of the prostheses ranged between 14 and 27 mm.Results: The overall hospital mortality was 17.1% (6/35), and decreased from 33 (1974–1985) to 11.5% (1986–1997). Seven children died late. The actuarial survival after 20 years was 51.2±13.3%. Eight patients (23%) required 10 reoperations (8.2%/100 patient-years). Freedom from reoperation at 10 years was 50±22%. Valve-related complications were thrombo-embolism (n=2; 1.6%/100 patient-years), hemorrhage (n=1; 0.8%/100 patient-years), structural deterioration (n=3; 2.5%/100 patient-years) and non-structural dysfunction (n=3; 2.5%/100 patient-years). Follow-up is 96% complete, with a total of 122 patient-years (mean=4.2±4.7 years). Eighty six percent of the patients are in New York Heart Association (NYHA) class I, 95% have sinus rhythm and 59% do not need medication. All survivors, except for those who received a bioprosthesis, were placed on a regimen of Phenprocoumon (Marcumar®), aiming to maintain the International Normalized Ratio (INR) between 2.5 and 3.5. In one third of these children, self-management of oral anticoagulation was performed either by the patients or their parents.Conclusions: MVR in small children still carries a high risk. In our experience, the long-term results are satisfying. After failed reconstructive surgery, or as a primary procedure, we prefer mechanical prostheses. They are well tolerated and the incidence of anticoagulation-related complications is low.

Key Words: Mitral-valve replacement • Children • Mechanical prostheses




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