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(Circulation. 2001;104:I-143.)
© 2001 American Heart Association, Inc.

Surgery for Congenital Heart Disease

Long-Term Survival After Mitral Valve Replacement in Children Aged <5 Years

A Multi-Institutional Study

Christopher A. Caldarone, MD; Geetha Raghuveer, MD; Christine B. Hills, BA; Dianne L. Atkins, MD; Trudy L. Burns, PhD; Douglas M. Behrendt, MD; James H. Moller, MD

Departments of Surgery (C.A.C., D.M.B.) and Pediatrics (G.R., D.L.A.), University of Iowa College of Medicine, and the Department of Biostatistics (T.L.B.), the University of Iowa College of Public Health, Iowa City, and the Pediatric Cardiac Care Consortium (C.B.H., J.H.M.) and the University of Minnesota (J.H.M.), Minneapolis.

Correspondence to Christopher A. Caldarone, MD, Department of Cardiothoracic Surgery, University of Iowa College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242. E-mail christopher-caldarone{at}uiowa.edu

Background— Short- and long-term outcomes after prosthetic mitral valve replacement (MVR) in children aged <5 years are ill-defined and generally perceived as poor. The experience of the Pediatric Cardiac Care Consortium (45 centers, 1982 to 1999) was reviewed.

Methods and Results— MVR was performed 176 times on 139 patients. Median follow-up was 6.2 years (range 0 to 20 years, 96% complete). Age at initial MVR was 1.9±1.4 years. Complications after initial MVR included heart block requiring pacemaker (16%), endocarditis (6%), thrombosis (3%), and stroke (2%). Patient survival was as follows: 1 year, 79%; 5 years, 75%; and 10 years, 74%. The majority of deaths occurred early after initial MVR, with little late attrition despite repeat MVR and chronic anticoagulation. Among survivors, the 5-year freedom from reoperation was 81%. Age-adjusted multivariable predictors of death include the presence of complete atrioventricular canal (hazard ratio 4.76, 95% CI 1.59 to 14.30), Shone’s syndrome (hazard ratio 3.68, 95% CI 1.14 to 11.89), and increased ratio of prosthetic valve size to patient weight (relative risk 1.77 per mm/kg increment, 95% CI 1.06 to 2.97). Age- and diagnosis-adjusted prosthetic size/weight ratios predicted a 1-year survival of 91% for size/weight ratio 2, 79% for size/weight ratio 3, 61% for size/weight ratio 4, and 37% for size/weight ratio 5.

Conclusions— Early mortality after MVR can be predicted on the basis of diagnosis and the size/weight ratio. Late mortality is low. These data can assist in choosing between MVR and alternative palliative strategies.

Key Words: mitral valve • survival • pediatrics • prosthesis