Safety and Efficacy of Mitral Valvuloplasty and Mitral Valve Replacement in Infants Less Than One Year Old

• Published in: Pediatrics (Evanston) 2019-08, Vol.144 (2_MeetingAbstract), p.330-330
• Main Authors: Geoffrion, Tracy R., Guleserian, Kristine J., Pirolli, Timothy J., Pruszynski, Jessica, Dyer, Adrian K., Davies, Ryan R., Forbess, Joseph
• Format: Article
• Language: English
• Subjects: Fatalities; Infants; Mitral valve; Pediatrics; Regurgitation; Risk factors; Stenosis; Surgery; Survival
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.144.2MA4.330

Objectives Data is limited on outcomes associated with mitral valve surgery in infants. Prior studies report very high mortality and increased risk for late cardiac failure in those with mitral stenosis. We sought to evaluate outcomes in patients with mitral stenosis (MS) or regurgitation (MR) who had mitral valvuloplasty or replacement in the first year of life. Methods A retrospective analysis of all patients who underwent mitral valvuloplasty or replacement in their first year of life from 2004 to 2016 (n=26), excluding patients undergoing surgery for any form of atrioventricular canal defect. Results Median age and weight at surgery were 75 days (2-329) and 4.6 kilograms (3.0 -10.1). The primary mitral pathology was MR in 17 patients and MS in 9 patients. Median follow-up was 3.6 years (27 days- 12.3 years). Overall survival was 96.2% at 30 days and 88.3% at 1 year. There were 3 deaths (11.5%), all within 6 weeks of surgery. There were no late deaths. Four patients required valve replacement, two of whom died within 30 days of surgery. Re-intervention-free survival was 83.8%, 73.3%, and 48.9% at 1, 5, and 10 years (Figure 1). There was no difference in reintervention-free survival between patients with MR versus MS. No risk factors for death or re-intervention were identified. Conclusions Mitral valvuloplasty and replacement can be performed in infants under 1 year of age with few early deaths and excellent mid and long-term survival.