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The Annals of Thoracic Surgery, Vol 47, 720-724, Copyright © 1989 by The Society of Thoracic Surgeons
TN Zweng, MK Bluett, R Mosca, LB Callow and EL Bove
Between 1976 and 1986, 19 children aged 1 month to 5 years underwent
replacement of the mitral (systemic atrioventricular) valve. Indications
for valve replacement included isolated congenital mitral stenosis (n = 2),
valve dysfunction associated with a more complex procedure (n = 15), and
failed valvuloplasty (n = 2). Seven different valve types were used; nine
were mechanical valves and ten were bioprosthetic valves. There were 6
hospital deaths (32%; 70% confidence limits, 20% to 47%). Among the 13
survivors there were 3 late deaths at a mean of 14 months after operation.
The late deaths were unrelated to valve malfunction. Thromboembolic events
occurred in 2 patients, both with mechanical valves. One minor bleeding
complication occurred among 10 patients on a regimen of Coumadin
(crystalline warfarin sodium). Five patients, all with bioprostheses,
required a second valve replacement. Indications for reoperation included
prosthetic valve regurgitation (n = 1) and calcific stenosis (n = 4). No
early or late deaths occurred after second valve replacement. Survival was
51% +/- 12% (standard error) at 112 months after valve replacement.
Analysis failed to identify age, weight, sex, previous operation,
underlying cardiac lesion, or prosthesis size and type as significant risk
factors for mortality. Mechanical valves had a lower reoperation rate
compared with bioprostheses. These data suggest that although mitral valve
replacement within the first 5 years of life is associated with a high
operative and late mortality, satisfactory long-term palliation for many
patients can be achieved. Mechanical valves are superior to bioprosthetic
valves, and offer the best long-term results.
ARTICLES
Mitral valve replacement in the first 5 years of life
Division of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor 48109.
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