Revisiting prosthesis choice in mitral valve replacement in children: Durable alternatives to traditional bioprostheses.
J Thorac Cardiovasc Surg
; 2020 May 31.
Article
en En
| MEDLINE
| ID: mdl-32713632
ABSTRACT
OBJECTIVE:
To determine risk factors for re-replacement and death or transplant following mitral valve replacement (MVR) in childrenMETHODS:
This is a retrospective 26-year review of patients younger than 20 years of age undergoing MVR between 1992 and 2018 at single institution. Outcomes included freedom from re-MVR and transplant-free survival. Cox proportional hazards regression models assessed association between outcomes and potential risk factors.RESULTS:
At median age 4.2 years, 190 children underwent 290 MVR 180 mechanical, 63 porcine, 13 pericardial, and 34 stented bovine jugular vein valves. Re-MVR occurred in 100 valves. Freedom from re-MVR at 5 and 10 years was 76% and 44%. Times to re-MVR were associated with prosthesis type (P < .001), with porcine and pericardial valves at greatest risk. Other risk factors for prosthetic failure included smaller prosthesis size and left ventricular hypoplasia. There were 9 transplants and 44 deaths. Transplant-free survival at 5 and 10 years was 81% and 76%. Prosthesis type was significantly associated with time to death/transplant in univariate analysis only (P = .021), with porcine at greater risk than mechanical. Independent risk factors for death/transplant included larger indexed geometric orifice area and longer bypass time.CONCLUSIONS:
In pediatric patients undergoing MVR, mechanical and stented bovine jugular vein valves were associated with increased durability compared with fixed-diameter bioprosthetic alternatives.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Tipo de estudio:
Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Revista:
J Thorac Cardiovasc Surg
Año:
2020
Tipo del documento:
Article