Long-term survival after mitral valve replacement in children aged < 5 years

Background-Short- and long-term outcomes after prosthetic mitral valve repl acement (MVR) in children aged <5 years are ill-defined and generally perce ived as poor. The experience of the Pediatric Cardiac Care Consortium (45 c enters. 1982 to 1999) was reviewed. Methods and Results-MVR was performed 176 times on 139 patients. Median fol low-up was 6.2 years (range 0 to 20 years, 96% complete). Age at initial MV R was 1.9 +/- 1.4 years. Complications after initial MVR included heart blo ck requiring pacemaker (16%), endocarditis (6%). thrombosis (3%), and strok e (2%). Patient survival was as follows: I year, 79%; 5 years. 75%; and 10 years, 74%. The majority of deaths occurred early after initial MVR, with l ittle late attrition despite repeat MVR and chronic anticoagulation. Among survivors, the 5-year freedom from reoperation was 81%. Age-adjusted multiv ariable predictors of death include the presence of complete atrioventricul ar canal (hazard ratio 4.76, 95% Cl 1.59 to 14.30), Shone's syndrome (hazar d ratio 3.68, 95% Cl 1.14 to 11.89), and increased ratio of prosthetic valv e size to patient weight (relative risk 1.77 per mm/kg, increment, 95% Cl 1 .06 to 2.97). Age- and diagnosis-adjusted prosthetic size/weight ratios pre dicted a 1-year survival of 91% for size/weight ratio 2, 79% for size/weigh t 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 diag nosis and the size/weight ratio. Late mortality is low. These data can assi st in choosing between MVR and alternative palliative strategies.