Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia.
Division of Cardiothoracic Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia.
Ann Thorac Surg. 2023 Aug;116(2):322-329. doi: 10.1016/j.athoracsur.2023.04.035. Epub 2023 May 5.
Reports using a 15-mm mechanical valve for mitral valve replacement (MMVR) in children are limited. We review our center's operative and postoperative experience with this valve.
We performed a single-center retrospective chart review identifying patients having undergone MMVRs between 2009 and 2022. We analyzed short- and long-term outcomes using descriptive statistics.
Fifteen patients underwent 16 MMVRs with no operative deaths. The median age and weight at the time of operation was 6.2 months (interquartile range [IQR] 4.4-13.7), and 5.16 kg (IQR 4.5-6.9), respectively. Ten implants (66%) were placed in the supraannular position. Median postoperative duration of intubation was 1.5 days (IQR 1.0-3.75), cardiac intensive care unit length of stay was 6 days (IQR 3-13.5), and overall hospital length of stay was 17.0 days (IQR 12-48.5). Three patients (20%) experienced major adverse events postoperatively. Four of 13 patients discharged home (31%) required readmission within 30 days for subtherapeutic/supratherapeutic international normalized ratio values. There were no surgical mortalities and 4 late mortalities (27%). Six patients underwent subsequent MMVR at a median time to second MMVR of 6.8 (IQR 3.6-8.9) years. There are 6 patients with the original 15-mm MVR at a median time of 4.7 years since placement.
We present the largest single-center cohort of patients having undergone 15-mm MMVR. Our experience is distinguished by a lower rate of major adverse events than previously reported, durability of the device, and a rapid postoperative recovery time. Appropriate and consistent anticoagulation is a notable challenge in this age group.
有关儿童二尖瓣置换术（MMVR）中使用 15 毫米机械瓣膜的报告有限。我们回顾了我们中心在该瓣膜方面的手术和术后经验。
我们进行了一项单中心回顾性图表审查，确定了 2009 年至 2022 年间接受 MMVR 的患者。我们使用描述性统计分析了短期和长期结果。
15 名患者接受了 16 例 MMVR，无手术死亡。手术时的中位年龄和体重分别为 6.2 个月（四分位距 [IQR] 4.4-13.7）和 5.16 公斤（IQR 4.5-6.9）。10 个植入物（66%）置于瓣环上方。中位术后拔管时间为 1.5 天（IQR 1.0-3.75），心脏重症监护病房住院时间为 6 天（IQR 3-13.5），总住院时间为 17.0 天（IQR 12-48.5）。术后 3 名患者（20%）发生重大不良事件。13 名出院回家的患者中有 4 名（31%）在 30 天内因治疗不足/治疗过度的国际标准化比值而需要再次入院。无手术死亡，4 例晚期死亡（27%）。6 名患者在第二次 MMVR 的中位时间为 6.8（IQR 3.6-8.9）年后再次接受 MMVR。6 名患者在放置后中位时间为 4.7 年后仍保留 15 毫米的原始 MVR。
我们提出了最大的单中心接受 15 毫米 MMVR 的患者队列。我们的经验与以前报道的重大不良事件发生率较低、器械耐久性以及术后快速恢复时间区分开来。在这个年龄段，适当和一致的抗凝是一个显著的挑战。
